Most Patients, Surgeons Opt for Breast Conservative Surgery

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Most patients get a recommendation for breast conservative surgery from their doctors according to a study in the Oct 14 issue of the journal JAMA.

Monica Morrow, MD, of Memorial Sloan-Kettering Cancer Center, and colleagues conducted a survey of women aged 20 to 79 years with intraductal or stage I and II breast cancer diagnosed between June 2005 and February 2007 who were included in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registries for Los Angeles and Detroit. Of the 3133 patients sent surveys, 2290 responded. The final sample included 1984 patients.

The purpose of the survey was to done to look at the perceived increase in mastectomies being done over the past several years. Current day mastectomies aren’t the equivalent of those done more than 20 years ago, and reconstructive options are much improved.

Good reasons for mastectomy include planned prophylactic mastectomy of the contralateral breast for particularly high risk women and more advanced cancers. For cancers found early, conservative options like a lumpectomies have been shown by randomized studies to have equivalent survival to mastectomies.

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The researchers found that doctors recommended lumpectomy more than 75% of the time. Of women who underwent lumpectomy, 12% ended up needing a mastectomy.

A third of the women advised to get a mastectomy sought a second opinion. Second opinions usually agreed with the first (87.9%). Only 1.9% of the women opted for mastectomy when both surgeons recommended against it.

Nearly a tenth (8.8%) of the women who had a mastectomy, did so on their own preference.

Morrow and colleagues said the findings indicate that surgeons have already largely adopted mastectomy when appropriate contraindications to breast conserving surgery exist, and that they accurately determine candidates for breast conserving surgery.

It is important to remember as the researchers noted, the study relied on patient recall, without confirmation of what surgeons actually discussed and recommended for surgery. It is also important to note that the nonresponse and missing data might have biased some of the results.

Source
Surgeon Recommendations and Receipt of Mastectomy for Treatment of Breast Cancer; JAMA, October 14, 2009, Vol 302. No 14, pp1551-1556; M. Morrow, R. Jagsi, A. K. Alderman, J.J. Griggs, S.T. Hawley, A.S. Hamilton, J.J. Graff, S.J. Katz

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