Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

High Mastectomy Rates Due to Breast Cancer Patients’ Choices

07.06.2004


As surgeons develop ways to make breast cancer treatment less invasive and less disfiguring, mastectomy rates have remained surprisingly high, causing many researchers to suspect doctors are not giving their patients these options. But a new study shows it’s the patients who are choosing the more aggressive surgery.



Researchers at the University of Michigan Comprehensive Cancer Center and Wayne State University found that women with breast cancer who said they made their own treatment decision were more likely to have a mastectomy than women who said their surgeon made the decision. Among women who had a mastectomy, fewer than a third received reconstructive surgery to create a new breast.

Results of the study will be presented Monday, June 7, in poster presentations at the annual meeting of the American Society of Clinical Oncology in New Orleans.


Breast conserving surgery, called lumpectomy, is a less invasive option for women with breast cancer. The surgery involves removing only the tumor and a small margin of tissue around it, and cosmetic results can be almost unnoticeable. Meanwhile, advances in reconstructive surgery have allowed doctors to improve the cosmetic results of mastectomy, which removes the whole breast.

Despite these advances, mastectomy rates have remained persistently high.

“Our research found that it’s the patients who seem to prefer mastectomy to breast conserving therapy. Increasing patients’ involvement in treatment decisions may actually drive mastectomy rates even higher,” says study author Steven Katz, M.D., MPH, associate professor of internal medicine at the U-M Medical School and of health management policy at the U-M School of Public Health.

The researchers surveyed 1,726 women in Los Angeles and Detroit metropolitan areas an average of six months after surgery for breast cancer. Average age was 59 and most women had at least some college education. Participants were asked what influenced their surgical decision, who made the decision (patient, doctor or both), how satisfied they were with their surgery choice, and their current quality of life.

Most women, 41 percent, said they made the choice about treatment, either alone or with their surgeon’s input, while 37 percent said the decision was jointly made; 22 percent of women said their surgeon made the decision.

All women surveyed reported being most concerned about their cancer coming back and said that was the primary basis for their treatment decision. Women who were most influenced by concerns about recurrence or the effects of radiation therapy, which is standard after lumpectomy, were more likely to have received mastectomy.

Only 30 percent of women choosing mastectomy opted for reconstructive surgery, which creates a new breast after the breast is removed. Women who received reconstruction reported lower quality of life scores than either women with mastectomy alone or breast conserving surgery, particularly with regard to body image.

“We may have surveyed the women too early to capture the potential benefit of reconstruction,” says study co-investigator Nancy Janz, Ph.D., associate professor of health behavior and health education in the U-M School of Public Health and a member of the U-M Comprehensive Cancer Center.

Overall, women said they were satisfied with their surgery decision, with just under 11 percent saying they wished they had made a different choice. Satisfaction depended on how involved women were in the decision process – and how involved they wanted to be.

Women who reported wanting more involvement in the decision-making process were 3.3 times more likely to be dissatisfied with their surgery and twice as likely to regret their choice as women who participated in the process to the degree they wanted. These women were also more than 5 times as likely to be unhappy with the decision-making process.

But women who said they were more involved than they wanted to be also had a greater chance of being unhappy with their outcome: 1.5 times more likely to report low satisfaction with their surgery, and 1.7 times more likely to regret the decision.

“Getting patients more involved in the treatment process will increase satisfaction among some women. But not all patients want to play a key role in the decision process. What’s more important is to match the patient’s preferences with her actual degree of participation in the surgery decision,” says co-investigator Paula Lantz, Ph.D., a member of the U-M Comprehensive Cancer Center and associate professor of health management and policy at the U-M School of Public Health.

Katz notes that an additional funded study is focusing on the perspectives of the patients’ surgeons regarding treatment issues and communication. The researchers also anticipate additional funding to study treatment decisions and outcomes in Latina women with breast cancer.

Funding for the studies was from the National Cancer Institute. In addition to Katz, Janz and Lantz, study authors were Angela Fagerlin, Ph.D., Barbara Salem, MSW, Indu Lakhani and Mahasin Mujahid, all from the U-M Department of Internal Medicine; Kendra Schwartz, M.D., MSPH, from Wayne State University and the Metropolitan Detroit Cancer Surveillance System; Lihua Liu, Ph.D., and Dennis Deapen, Ph.D., from University of Southern California; and Monica Morrow, M.D., from Northwestern University.

Kara Gavin | newswise
Further information:
http://www.med.umich.edu/opm/newspage/reporter.htm

More articles from Health and Medicine:

nachricht Study tracks inner workings of the brain with new biosensor
16.08.2018 | Rheinische Friedrich-Wilhelms-Universität Bonn

nachricht Foods of the future
15.08.2018 | Georg-August-Universität Göttingen

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: It’s All in the Mix: Jülich Researchers are Developing Fast-Charging Solid-State Batteries

There are currently great hopes for solid-state batteries. They contain no liquid parts that could leak or catch fire. For this reason, they do not require cooling and are considered to be much safer, more reliable, and longer lasting than traditional lithium-ion batteries. Jülich scientists have now introduced a new concept that allows currents up to ten times greater during charging and discharging than previously described in the literature. The improvement was achieved by a “clever” choice of materials with a focus on consistently good compatibility. All components were made from phosphate compounds, which are well matched both chemically and mechanically.

The low current is considered one of the biggest hurdles in the development of solid-state batteries. It is the reason why the batteries take a relatively long...

Im Focus: Color effects from transparent 3D-printed nanostructures

New design tool automatically creates nanostructure 3D-print templates for user-given colors
Scientists present work at prestigious SIGGRAPH conference

Most of the objects we see are colored by pigments, but using pigments has disadvantages: such colors can fade, industrial pigments are often toxic, and...

Im Focus: Unraveling the nature of 'whistlers' from space in the lab

A new study sheds light on how ultralow frequency radio waves and plasmas interact

Scientists at the University of California, Los Angeles present new research on a curious cosmic phenomenon known as "whistlers" -- very low frequency packets...

Im Focus: New interactive machine learning tool makes car designs more aerodynamic

Scientists develop first tool to use machine learning methods to compute flow around interactively designable 3D objects. Tool will be presented at this year’s prestigious SIGGRAPH conference.

When engineers or designers want to test the aerodynamic properties of the newly designed shape of a car, airplane, or other object, they would normally model...

Im Focus: Robots as 'pump attendants': TU Graz develops robot-controlled rapid charging system for e-vehicles

Researchers from TU Graz and their industry partners have unveiled a world first: the prototype of a robot-controlled, high-speed combined charging system (CCS) for electric vehicles that enables series charging of cars in various parking positions.

Global demand for electric vehicles is forecast to rise sharply: by 2025, the number of new vehicle registrations is expected to reach 25 million per year....

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

LaserForum 2018 deals with 3D production of components

17.08.2018 | Event News

Within reach of the Universe

08.08.2018 | Event News

A journey through the history of microscopy – new exhibition opens at the MDC

27.07.2018 | Event News

 
Latest News

Quantum bugs, meet your new swatter

20.08.2018 | Information Technology

A novel synthetic antibody enables conditional “protein knockdown” in vertebrates

20.08.2018 | Life Sciences

Metamolds: Molding a mold

20.08.2018 | Information Technology

VideoLinks
Science & Research
Overview of more VideoLinks >>>