September 22, 2005
Women often opt for mastectomy for breast cancer
NEW YORK (Reuters Health) - 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
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
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,
The survey also revealed racial and ethic differences in
women's perceptions and experiences about the treatment
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
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
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.