Expert: Ronald Levy, M.D. - 8/13/2007

Question
QUESTION: I am 56 and in good health except I had a mastectomy last year for left sided breast cancer stage 1.  I am considering having the left side done prophylactically but after reading about anesthesia and possible alzheimer like changes in the brain with some research done in this area I now am feeling lots of trepidation.  Bottom line is I worry about any dementia type decline, memory loss, brain cell changes due to anesthesia.  Is there some type that we know will  not be as risky for a mastectomy (no lymph nodes) surgery?  I am a nurse and do lots of research when I have a health issue and don't want to do something I will regret later.  I also smoked from age 20 to 27 and worry about inhalation of anesthesia during surgery too.  I sound like a worrier but I just want to make the right decisions.  Thank you so much.  Margaret O'Sullivan RN, MSN

ANSWER: I have never heard of Alzheimer like changes from anesthesia and I can only tell you to take what you read on the internet with a grain of salt. It is not peer-reviewed so people can say whatever they want. As for inhalation of anesthesia after quitting smoking >20 yrs ago, don't worry. If you smoke for a relatively short time, the chronic changes are minimal. With regard to prophylactic mastectomy, that's up to you and your surgeons advise about risks of contralateral spread, etc.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston

---------- FOLLOW-UP ----------

QUESTION: Thank you for the follow up:  I read the article from JAMA Vol 297, No. 16, April 25,2007 entitled "Anesthesia-Alzheimer Disease Link Probed" .  It starts:  Some commonly used inhaled anesthetics may cause brain damage that accelerates the onset of Alzheimer disease, according to recent findings from two separate groups of scientists.  For more than a decade, physicians and scientists have searched for clues to why some people experience cognitive dysfunction after undergoing anesthesia and surgery.   Another article from March 14, 2007 states "Penn Study Finds Inhaled Anesthetics Could Lead to Early Onset of Alzheimer's Disease"  and says "Researchers at Penns School of Medicine have discovered that common inhaled anesthetics increase the number of amyloid plaques in the brains of animals.....this written by Roderic Eckenhoff, MD Vice Chair of Research in the UofP Department of Anesthesia.  Do you specialists in practice consider these articles not really significant enough for a person to consider like myself.  I don't want to worry about ridiculous things but I also don't want to do a preventative procedure that is not really necessary and possibly cause more risk to myself as I have a 13 year old and need to be pretty with it for many more years. I will appreciate your thoughts.  Thank you very much.

Answer
Most of the studies linking the two have more to do with how certain anesthetics (like isoforane) can induce the release of certain chemicals (which are also found in alzheimer's disease [AD]) in cell cultures. These studies are at the basic science level and while they may theoretically increase the risk of AD, I am not aware of any clinical studies that show a significant link between the two. The risk of certain types of breast cancer (namely lobular) being found on the opposite breast has been definitely shown. So given the known risk versus a thoeretical risk, I would not let the fear of the anesthesia guide your decision. I am not telling you that you should have a prophylactic mastectomy (that decision is up to you and your surgeon). I am saying to make your decision without concern about anesthesia causing AD. Bear in mind that medical research is about statistics and until a study has undergone rigorous review AND confirmation, we tend to read them with interest without necessarily changing our practice. In recent years, physicians have been relying on evidence based medicine (EBM) to help with treatment decisions. Without going into too much detail (you can do a search on EBM to find out the details), without level 1 evidence, we do not recommend following that treatment standard. As far as I know, there is no level 1 evidence regarding anesthesia and AD.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston