There seems to be a concern that mastectomy is excessively utilized as a treatment in the United States. Apparently, this raises questions about the role of surgeons and patient preference in selecting treatment for breast cancer. According to a latest study, breast-conserving surgery was presented and attempted in nearly all the patients who were evaluated. Suggestions of the surgeon, patient decisions, and failure of breast-conserving surgery appear to be contributing factors to the mastectomy rate.
During the study, Dr. Morrow along with his colleagues was believed to have carried out a study in order to establish the reasons why women undergo initial mastectomy for treatment of breast cancer. Also, to find out the frequency of mastectomy after BCS is attempted.
The study consisted of a survey of women between the ages 20 to 79 years with intraductal or stage I and II breast cancer diagnosed between June 2005 and February 2007. Supposedly, these study participants reported to the National Cancer Institute’s Surveillance, Epidemiology, and End Results registries for the metropolitan areas of Los Angeles and Detroit. The final survey sample was observed to have included nearly 1,984 female patients wherein there were 502 Latinas, 529 blacks, and 953 non-Hispanic white or other.
The research findings revealed that out of the patient population, nearly 75.4 percent seem to have BCS as an initial surgical therapy while 23 percent had initial mastectomy. Also, approximately 13.4 percent were believed to have obtained initial mastectomy based on surgeon recommendation.
Moreover, about 8.8 percent received initial mastectomy when the first surgeon did not recommend one procedure over another or recommended BCS. Additionally, about 8.8 percent appear to have received mastectomy after unsuccessful attempts at BCS. Of the 1,984 patients, nearly 19.1 percent were observed to have wanted a second opinion about surgical options prior to treatment.
“This was more common for women with a higher education level and for those advised to undergo mastectomy (33.4 percent) vs. those advised to have BCS (15.6 percent) or those who did not receive a recommendation for one procedure over another (21.2 percent),” says Monica Morrow, M.D., of Memorial Sloan-Kettering Cancer Center, New York.
“The results of this study suggest that most surgeons in 2 large, diverse urban regions appropriately recommended local therapy options for patients with breast cancer. The majority of women who received a surgeon recommendation for initial mastectomy reported a clinical contraindication to breast conservation,” explains Dr Morrow.
The findings also revealed that 11.9 percent of patients who received an initial BCS recommendation obtained a second opinion for mastectomy whereas 12.1 percent of the patients who consulted a second surgeon received a harsh opinion. In addition, among the 1,459 women for whom BCS was attempted, additional surgery appears to have been needed in 37.9 percent of patients. Mastectomy seems to have been most common in patients with stage II cancer.
Dr Morrow further stated that, “Our results also suggest that patient preferences may play an important role in shaping the pattern of surgical treatment for breast cancer. One-third of patients appear to choose mastectomy as initial treatment when not given a specific recommendation for BCS or mastectomy by their surgeon, accounting for about one-quarter of total mastectomy use. Patients may prefer mastectomy for peace of mind or to avoid radiation.”
“In conclusion, findings of this survey of women with breast cancer demonstrate that the etiology [cause] of current mastectomy rates is multifactorial, but that BCS is recommended by surgeons and attempted in a majority of patients. Our findings suggest that a combined approach of education for patients and health care professionals targeting specific areas may improve decision making,” he continues.
Concerns about excessive use of mastectomy for patients with breast cancer seem to have been raised for more than 2 decades. It was noted that rates of breast-conserving surgery (BCS) have been utilized by some as a quality measure. In spite of a marked increase in BCS, concerns continue that women with breast cancer may have been overtreated with mastectomy.
The findings of the study have been published in the Journal of the American Medical Association (JAMA).