Breast cancer

15 October 2009

Mastectomy not always the first choice

Contrary to common belief, most women diagnosed with breast cancer are not turning to mastectomy as their first choice for treatment, research has shown.


Contrary to common belief, most women diagnosed with breast cancer are not turning to mastectomy as their first choice for treatment, but are first trying more conservative approaches, such as lumpectomy, a new survey has found.

The survey, reported in the Journal of the American Medical Association, also found that US doctors are doing a good job of presenting newly diagnosed breast cancer patients with a range of treatment options.

The researchers found that those women who did opt for mastectomy instead of breast-conserving surgery often did so because of their own preference, and probably because of the perception that mastectomy offered better odds against the cancer coming back.

However, "the chances of surviving breast cancer are the same whether you have a lumpectomy or a mastectomy," noted the study's lead author, Dr Monica Morrow, chief of the breast service and chairwoman of clinical oncology at Memorial Sloan-Kettering Cancer Centre in New York City.

"There's an overwhelming feeling that somehow 'bigger' surgery is better surgery," Morrow said. "It's something I hear over and over again: 'I want to be safe so I will have the mastectomy.' "

How the study was done
The researchers wrote in their report that they undertook the study because there's been a perception that women have been given mastectomies unnecessarily, when breast-conserving surgery might have been an option.

The team reviewed data from the US National Cancer Institute's Surveillance, Epidemiology and End Results registries in Los Angeles and Detroit. They included data on 1 984 women with intraductal, stage 1 or stage 2 breast cancer who completed a telephone survey about their experience with cancer surgery.

The women, 20 to 79 years old, included 953 women who listed their race as white or other, 502 Hispanic women and 529 black women.

Most of the women – 75% - chose breast-conserving surgery initially. According to Morrow, some women who chose breast-conserving surgery eventually had a mastectomy, and these were typically women with larger, stage 2 tumours. The choice did not appear to be affected by race, education or where a woman was treated, Morrow noted.

Of those who initially underwent mastectomy, many could identify the reason that mastectomy was the best option for them, suggesting that it was something discussed in detail with their doctor.

What the study revealed
Almost 9% of the women chose to have a mastectomy because of personal preference.

Nearly one in five women sought a second opinion, and women with higher education levels were more likely to do so. But, regardless of education level, the researchers found that getting a second opinion was rarely a deciding factor in choosing the type of treatment.

"Most of the time, a second opinion didn't make a difference in the recommendations that a woman is offered," she said. "So if you feel comfortable with your surgeon, don't feel obligated to seek a second opinion."

Additional surgery was required in about 38% of women who first underwent a lumpectomy, according to the survey.

"This study addresses the concern that mastectomy is overused, and I really don't think it's being overused," said Dr Nora Jaskowiak, an associate professor of surgery and the surgical head of the University of Chicago Breast Centre. "Surgeons definitely try to save as many breasts as is reasonable to do."

"Patients and surgeons can discuss the options, and together they will make the best decision for that woman," she said. – (HealthDay News, October 2009)


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Breast cancer expert

Dr Gudgeon qualified in Birmingham, England, in 1968. She has more than 40 years experience in oncology, and in 1994 she founded her practice, Cape Breast Care, where she treats benign and malignant breast cancers. Dr Boeddinghaus obtained her qualification at UCT Medical School in 1994 and her MRCP in London in 1998. She has worked extensively in the field of oncology and has a special interest in the hormonal management of breast cancer. She now works with Dr Gudgeon at Cape Breast Care. Read more.

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