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examines Mastectomy and Breast-conserving
Newswise — There is concern that mastectomy
is over-utilized in the United States, which
raises questions about the role of surgeons
and patient preference in treatment
selection for breast cancer.
New data from an observational study found
that breast-conserving surgery was presented
and provided in the majority of patients
Surgeon recommendations, patient decisions,
and failure of breast-conserving surgery
were all found to be contributing factors to
the mastectomy rate.
The findings are published in the October 14
2009 issue of the Journal
of the American Medical Association (JAMA),
a theme issue on surgical care.
The study was lead by Monica Morrow MD,
Chief of the Breast Service in the
Department of Surgery at Memorial
Sloan-Kettering Cancer Center, along with
Steven Katz MD, MPH, and colleagues at the
University of Michigan Comprehensive Cancer
Dr. Morrow and colleagues were interested in
investigating the factors responsible for
the overall mastectomy rate in the United
States and why women undergo mastectomy for
the initial treatment of breast cancer.
The findings suggest that surgeons are
appropriately recommending breast-conserving
surgery and that patient preferences play an
important role in shaping the pattern of
surgical treatment for breast cancer,
especially in the absence of a surgeon
recommendation favoring one procedure over
This is consistent with previous studies
performed by these investigators that have
shown that when both procedures are
medically appropriate, increased patient
involvement in breast surgery decisions is
associated with greater probability of
In this study, one-third of patients appear
to choose mastectomy as initial treatment
when not given a specific recommendation for
mastectomy by their surgeons.
Researchers speculate that patients may
prefer mastectomy for “peace of mind” or to
avoid radiation and are often strongly
influenced by concerns about disease
recurrence and fear.
“Women need to understand that although it
intuitively seems obvious that a bigger
surgery is a better surgery-it may not be
the case here.
are some patients for whom mastectomy is the
best medical treatment, but when it is not
indicated, women need to make sure that if
they are choosing mastectomy as a matter of
preference that they understand that it is
not going to improve the likelihood of
breast cancer survival.
risk of cancer recurring in the breast after
a lumpectomy is basically no different than
the risk of cancer recurring in the scar
tissue of a mastectomy,” said Dr. Morrow.
Concerns about the excessive use of
mastectomy for patients with breast cancer
have been raised for decades despite a
marked increase in breast-conserving surgery
in recent years.
According to a 2008 study (by the Mayo
Clinic), mastectomy rates were 45 percent in
1997, dropped to 30 percent in 2003, but
then increased to 43 percent in 2006.
In this new study, Dr. Morrow and colleagues
found that of 1984 women aged 20 to 79 years
with stage 1 and 2 breast cancer that was
diagnosed between June,2005 and
February,2007: 67 percent of women reported
that their first surgeon recommended
breast-conserving surgery and that they had
successful procedures; 13 percent had
mastectomies after initial surgical
recommendation; 8.8 percent had mastectomies
when there was no clear surgical
recommendation for either procedure; and
finally, an additional 8.8 percent reported
having unsuccessful breast-conserving
surgery that required revision with
The results are based on data reported to
the metropolitan Los Angeles and Detroit
Surveillance, Epidemiology and End Results
“Our results and those from other studies we
performed suggest that surgeons face special
challenges in how they discuss treatment
options and elicit the treatment preferences
of their patients with breast cancer.
results reinforce that both patient
preferences and surgeon recommendations are
powerful determinants of treatment,” said
Dr. Katz, who is a professor of internal
medicine and health management and policy at
the University of Michigan.
“This study suggests that breast-conserving
surgery has been appropriately adopted by
surgeons and for most women- if they are
given a specific reason why they are not a
good candidate for breast-conserving
surgery, a second opinion is not likely to
change that,” said Dr. Morrow.
Funding for this study was provided by
grants from the National Cancer Institute
and the American Cancer Society to the
University of Michigan. Dr. Katz was
supported by an Established Investigator
Award in Cancer Prevention, Control,
Behavioral, and Population Sciences Research
from the NCI.
Memorial Sloan-Kettering Cancer Center is
the world’s oldest and largest private
institution devoted to prevention, patient
care, research, and education in cancer. Our
scientists and clinicians generate
innovative approaches to better understand,
diagnose, and treat cancer.
specialists are leaders in biomedical
research and in translating the latest
research to advance the standard of cancer
care worldwide. For more information, go to www.mskcc.org.