Options for women with unilateral breast cancer can be unilateral or bilateral mastectomy, lumpectomy and radiation -- which would be breast conserving therapy.

Researchers used data from the California Cancer Registry from 1998 through 2011 to compare the use of and rate of death after bilateral mastectomy, breast - conserving therapy with radiation, and unilateral mastectomy (removal of one breast). The analyses included 189,734 patients.

Previous data show increasing use of mastectomy, and particularly bilateral mastectomy (removal of both breasts) among U.S. patients with breast cancer. In the US the rates for bilateral mastectomy have increased by 14 per cent per year. Women under 40 were using this at a much higher rate. However, this did not offer a survival benefit.

The increase in bilateral mastectomy rate was greatest among women younger than 40 years: the rate increased from 3.6 percent in 1998 to 33.0 per cent in 2011, increasing by 17.6 per cent annually while use of unilateral mastectomy declined in all age groups. With unilateral cancer, there is cancer in one breast and woman can be at increased risk for recurrence or cancer in the contralateral breast. That risk is higher than a non -- cancer patient but it is still low.

Randomized trials have demonstrated similar survival for patients with early -- stage breast cancer treated with breast -- conserving surgery and radiation or with mastectomy.  Evidence for a survival benefit with this procedure appears limited to rare patient subgroups.

Researchers found that the rate of bilateral mastectomy increased from 2.0 per cent in 1998 to 12.3 per cent in 2011, an annual increase of 14.3 per cent.

Compared with breast -- conserving surgery with radiation, bilateral mastectomy was not associated with a mortality difference, whereas unilateral mastectomy was associated with higher mortality.

There is an increasing concern about overtreatment, the risk --benefit ratio of bilateral mastectomy warrants careful consideration and raises the larger question of how physicians and society should respond to a patient's preference for a morbid, costly intervention of dubious effectiveness. These results may inform decision --making about the surgical treatment of breast cancer.

The need for patients to be accurately informed regarding safe and oncologically acceptable treatment options is indisputable. The dense fog of complex emotions that accompanies a new cancer diagnosis can impair the ability to process this information. Patients should be encouraged to allow the intensity of these immediate reactions to subside before committing to mastectomy prematurely. Physicians should not permit excessive treatment delays to compromise outcomes, but the initial few weeks surrounding the diagnosis are more effectively utilized by time invested in patient education and procedures that contribute to comprehensive treatment planning as opposed to hastily coordinating impulsive, irreversible surgical plans.