Women often opt for mastectomy for breast cancer
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The results of a survey of a large group of women with early-stage breast cancer suggest that many women are involved in the treatment decision-making process, and that greater patient involvement in treatment decisions is associated with a greater likelihood of undergoing mastectomy.
There is general professional consensus that most women with early-stage breast cancer are good candidates for breast-conserving surgery. However, persistently high rates of mastectomy in these women have fueled concerns about over-treatment and failure to engage women in treatment decisions.
Dr. Steven J. Katz from the University of Michigan in Ann Arbor and colleagues examined the relationship between patient involvement in the decision-making process and the choice of surgical treatment (mastectomy or breast-conserving surgery) by surveying 1,844 women diagnosed with early breast cancer in 2002 in Detroit and Los Angeles.
According to a report in the Journal of Clinical Oncology, 70 percent of the women underwent breast-conserving surgery while 30 percent underwent mastectomy.
Overall, 41 percent of women reported that they made the decision about which surgery to have and 37 percent reported that the decision was shared with their physician. However, nearly 22 percent said their surgeon made the decision with or without their input.
Women also reported that surgeons who offered treatment recommendations were more apt to recommend breast-conserving surgery than mastectomy (49 percent vs. 15 percent, respectively).
The survey also revealed racial and ethic differences in women’s perceptions and experiences about the treatment decision-making process.
For example, compared with white women, African American women seemed to have a harder time choosing between mastectomy and breast-conserving surgery, sought opinions from more surgeons, had more visits before surgery, made decisions later, and reported receiving less information about breast-conserving surgery.
Although when decisions were made by surgeons breast-conserving surgery was more likely among white women, “this association was less evident for African American women,” Katz and colleagues report.
In fact, African American women were more likely to have undergone “mastectomy compared with the other ethnic groups when the decision was perceived to have been made by the surgeon.”
In a related editorial, Dr. Ann. B. Nattinger from the Medical College of Wisconsin in Milwaukee reminds clinicians that the decision-making process for treatment of early-stage breast cancer is “complex and…problematic for many patients, not only minority patients. Patients are often overwhelmed with information and may have difficulty eliciting information most germane to their situation.”
Innovative research on ways to improve the quality of the decision-making process “would be welcome,” she concludes.
SOURCE: Journal of Clinical Oncology, August 20, 2005.
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