Breast cancer patients pick invasive surgery, doctors say

Despite having the option of less aggressive surgery, nearly one-third of women who had a choice between mastectomy and lumpectomy chose the more invasive operation, doctors reported today.

A national team of scientists led by researchers at the University of Michigan found that when women made the choice without a physician’s influence, a significant percentage chose mastectomy.

Study participants who said their surgeons made the treatment choice were more likely to have received less aggressive operations.

In all, 1,822 women in Los Angeles and Detroit were studied. Scientists said the population reflected breast cancer patients nationwide. Researchers found that 30.2 percent chose mastectomy.

Thirty years ago, advocates for breast cancer patients fought vigorously for the medical community to study the benefit of less invasive surgery. Subsequent research proved that breast conservation – lumpectomy – plus six weeks of radiation was equal to mastectomy for a majority of women with early-stage breast cancer.

“The basic notion over the last 10 years has been that the relatively high mastectomy rate in the United States suggested surgeons were not doing the right thing and were not fully informing women of their choices,” said Dr. Steven Katz, a medical professor and lead investigator of the study.

Katz said the United States has the industrial world’s highest mastectomy rate; more than 33 percent of women who undergo the surgery for early-stage breast cancer receive mastectomies. American doctors have been criticized by for overtreatment.

Dr. Deborah Axelrod, director of clinical breast services at NYU Cancer Institute in Manhattan, who was not involved in Katz’s research, said women who might have spared themselves an invasive procedure probably were not well-informed.

“Not all women are candidates for lumpectomy, but it is a knee-jerk response for women to think that a mastectomy is better. It’s our responsibility as physicians to create a balance where the patient can make an informed decision,” she said.

Breast cancer survivor Geri Barish, president of 1 in 9: The Long Island Breast Cancer Coalition, said women tend to choose mastectomies because “they just want to get rid of the cancer. They don’t want it in their body.”

Others may choose it because of a family history of the disease.

Dr. Monica Morrow, who chairs the department of surgical oncology at Fox Chase Cancer Center in Philadelphia, said “fear of recurrence and fear of radiation” are other reasons.

Katz and Morrow, a co-author of the study, reported their results in today’s Journal of Clinical Oncology.

She added that doctors are largely at fault when women who could have had lumpectomies choose mastectomies. “We may not be clearly getting our message across,” she said.