Oct. 14, 2009 - With there being concern that
mastectomy is excessively used as a treatment for breast cancer, a
survey of nearly 2,000 women indicates that breast-conserving surgery
was attempted as the initial therapy for about 75 percent of those
surveyed, according to a study in the October 14 issue of the Journal of
the American Medical Association, a theme issue on surgical care.
Monica Morrow, M.D., of Memorial Sloan-Kettering
Cancer Center, New York, presented the findings of the study at a JAMA
media briefing in Chicago.
"Concerns about excessive use of mastectomy for
patients with breast cancer have been raised for more than 2 decades.
Rates of breast-conserving surgery (BCS) have been used by some as a
quality measure. Despite a marked increase in BCS, concerns persist that
women with breast cancer are being overtreated with mastectomy,"
according to background information in the article.
Dr. Morrow and colleagues conducted a study to
determine the reasons women undergo initial mastectomy for treatment of
breast cancer and the frequency of mastectomy after BCS is attempted.
The study consisted of a survey of women age 20 to
79 years with intraductal or stage I and II breast cancer diagnosed
between June 2005 and February 2007 and 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 included 1,984 female
patients (502 Latinas, 529 blacks, and 953 non-Hispanic white or other).
The researchers found that of the patient
population -
● 75.4% had BCS as an initial surgical therapy;
● 23% had initial mastectomy;
● 13.4% received initial mastectomy based on surgeon recommendation;
● 8.8% received initial mastectomy when the first surgeon did not
recommend one procedure over another or recommended BCS; and
● 8.8% received mastectomy after unsuccessful attempts at BCS.
Of the 1,984 patients 19.1 percent sought 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)," the authors write.
They also found that 11.9 percent of patients who
received an initial BCS recommendation received a second opinion for
mastectomy; 12.1 percent of the patients who consulted a second surgeon
received a discordant opinion. Among the 1,459 women for whom BCS was
attempted, additional surgery was required in 37.9 percent of patients.
Mastectomy was most common in patients with stage II cancer.
"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," the
authors write.
"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," the researchers
write. "Our findings suggest that a combined approach of education for
patients and health care professionals targeting specific areas may
improve decision making."
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