Study Suggests Mastectomy Not Being Overused For Breast Cancer Treatment
October 31, 2011
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Healthcare Prof:
With there being a concern that mastectomy is excessively used as a remedy for breast cancer, a survey of practically two,000 women indicates that breast-conserving surgery was attempted as the initial therapy for about 75 percent of those surveyed, according to a study inside the October 14 issue of JAMA, 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 a lot more than 2 decades. Rates of breast-conserving surgery (BCS) have been employed by some as a high quality measure. Regardless of a marked increase in BCS, concerns persist that females with breast cancer are getting overtreated with mastectomy,” based on background data inside the post.
Dr. Morrow and colleagues conducted a study to determine the factors girls undergo initial mastectomy for therapy of breast cancer along with the frequency of mastectomy right after BCS is attempted. The study consisted of a survey of girls age 20 to 79 years with intraductal or stage I and II breast cancer diagnosed in between June 2005 and February 2007 and reported to the National Cancer Institute’s Surveillance, Epidemiology, and End Outcomes registries for the metropolitan locations 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 discovered that of the patient population, 75.four percent had BCS as an initial surgical therapy; 23 percent had initial mastectomy; 13.four percent received initial mastectomy based on surgeon recommendation; 8.8 percent received initial mastectomy when the initial surgeon didn’t recommend 1 process more than one more or recommended BCS; and 8.8 percent received mastectomy soon after unsuccessful attempts at BCS.
Of the 1,984 patients, 19.1 percent sought a second opinion about surgical options prior to remedy. “This was a lot more widespread for women with a higher education level and for those advised to undergo mastectomy (33.four percent) vs. those advised to have BCS (15.6 percent) or those that did not obtain a recommendation for 1 process over an additional (21.two 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 females for whom BCS was attempted, additional surgery was required in 37.9 percent of patients. Mastectomy was most widespread in patients with stage II cancer.
“The results of this study suggest that most surgeons in two 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 outcomes also suggest that patient preferences may possibly play an essential role in shaping the pattern of surgical treatment for breast cancer. One-third of patients appear to choose mastectomy as initial remedy when not given a specific recommendation for BCS or mastectomy by their surgeon, accounting for about one-quarter of total mastectomy use. Patients may possibly prefer mastectomy for peace of mind or to avoid radiation.”
“In conclusion, findings of this survey of girls with breast cancer demonstrate that the etiology [cause] of existing 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 well being care professionals targeting specific areas may possibly increase decision creating.”
JAMA. 2009;302[14]:1551-1556.
Source
Journal of the American Medical Association
Filed under: French Village