THURSDAY, Aug. 18, 2005 (HealthDay News) -- Concerned about cancer recurrence, women with breast cancer often choose a mastectomy over a less-drastic lumpectomy when they have control over the decision, a new study found.
This, despite the fact that survival odds -- though not recurrence rates -- are the same with the two procedures.
The study findings appear in the August issue of the Journal of Clinical Oncology.
In recent years, medical practice guidelines have recommended that a lumpectomy, in which just part of the breast is removed, should be performed, if possible, in lieu of a mastectomy -- removal of the entire breast. But there has been concern among health experts that the mastectomy rate has remained high, said study lead author Dr. Steven Katz, associate professor of medicine and health management and policy at the University of Michigan Medical School in Ann Arbor.
"The issue is that surgeons have been blamed for being too aggressive with recommendations" for mastectomies, he said.
However, Katz's study suggests that it is often patients, not their surgeons, who are opting for the mastectomies.
"Some policy-makers have said that women are not adequately informed [about options for breast-cancer surgery], leading to legislative efforts in 20 states mandating women be informed of surgical options," he said.
The study findings, Katz said, suggest that surgeons are following policy recommendations and recommending the less-invasive treatment and that women are informed and usually involved in the decision-making process. "But the most interesting finding is, the more involvement [by women] reported, the more likely they receive a mastectomy," he said.
Katz and his colleagues surveyed 1,844 women in the Los Angeles and Detroit areas who had recently learned they had breast cancer. They were asked if they made the decision about surgical treatment, if their doctor did, or if both did and which options were discussed.
They found that among white women, who made up more than 70 percent of the sample, 27 percent who said they made the decision chose a mastectomy. This compared to just 5.3 percent of women who said their surgeon made the treatment choice, and 16.8 percent who said the decision was shared.
The study also found that African-American women seemed to have more difficulty reaching a decision -- they sought more opinions from more surgeons and made decisions later. But because the prognosis is similar for both mastectomy and lumpectomy, these differences in the decision-making process may not be significant, the study found.
Overall, 30.2 percent of the women underwent mastectomy as their initial treatment. Forty-one percent of those patients said they made that surgical decision, while 37.1 percent said it was shared decision and 21.9 percent said the surgeon made the decision -- with or without their input.
Those who chose mastectomy were likely to say they did so due to a fear of cancer recurrence or concerns about radiation treatment, which follows lumpectomy.
Women who chose mastectomy, Katz said, "view the mastectomy as a more complete treatment and it reduces their concern about the return of the cancer."
While survival rates between the two options is not different, the risk of recurrence is substantially higher in lumpectomy patients than in mastectomy patients.
"For all women with early stage disease -- that is noninvasive and early stage invasive -- their risk of recurrence is 15 to 20 percent over 10 years in the local breast, the one with cancer, versus 1 percent in those with mastectomy," Katz said.
Dr. Ann Nattinger, chief of the Division of General Internal Medicine at the Medical College of Wisconsin, wrote an accompanying editorial in the journal. In an interview, she said, "Methodologically this is a well-done study. It's well analyzed." In addition, "it is the first study that has looked systemically at how the decision was made," she added.
The message for women, Nattinger said, is "they should make sure they are making a decision consistent with their own values." They should also consider getting several opinions about treatment from different doctors.
Katz added that women should weigh their choices deliberately. While it's not wise to delay cancer treatments, women with breast cancer often have more time to make their therapy decisions than they think they do, he said.
Involve a patient advocate, a family member or friend to help sort out the options, Katz advised.
More information
To learn more about breast cancer, visit the American Cancer Society.
