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Can You Trust Your Mammogram?

Surgical Biases continued...

What you should do: Ask loads of questions, starting with, "Am I a candidate for breast-conserving surgery, and if not, why not?" advises Dr. Sariego. Do your own research. And don't be shy about asking the first surgeon to recommend another for a second opinion. Better yet, look on your own: A recent study shows you're more likely to wind up with someone experienced and affiliated with a cancer program, compared with women who rely on referrals from their doctor or health plan, says Steven Katz, M.D., professor of medicine and health management and policy at the University of Michigan.

While you're asking questions, find out how your lymph nodes will be tested to see if the cancer has spread. A newer procedure, called sentinel-node biopsy, is less invasive and far less likely to cause permanent arm swelling than old-fashioned lymph node removal, but about 35 percent of patients aren't getting it, a recent multicenter study found.

Post-Surgery Neglect

Lumpectomy is just as effective as mastectomy only if it includes lymph node testing and a course of radiation treatments — generally five days a week for about six weeks. That's something your surgeon should make clear before you choose one procedure over the other.

The news: In 2003, only 71 percent of lumpectomy patients followed through with radiation, down from 79 percent in 1992, University of Minnesota epidemiologist Beth Virnig, Ph.D., reported last December. "A lot of women with serious breast cancer are not getting comprehensive treatment," she says.

Why it matters: If you don't undergo a full course of radiation, your chances of local recurrence within 10 years are as high as 30 percent, says Dr. Katz. (If you do, they drop to about 8 to 10 percent.)

What you should do: Talk with a radiation oncologist before surgery. Ask how long your treatment will last and what the side effects might be. For that matter, talk with all the specialists who may be involved in your postsurgical care. Women often feel panicked and pressured to start treatment immediately, but it's usually safe to wait two to three weeks.

Reticence on Reconstruction

If a lumpectomy isn't right for you, a mastectomy followed by reconstruction is an alternative — but you may have to bring up the subject.

The news: Only about one-quarter of surgeons regularly send patients for a plastic surgery consultation before they make their lumpectomy or mastectomy decision, researchers from the University of Michigan found in a 2007 study. Who's most likely to make that referral? Women surgeons — as well as those who treat a lot of breast cancer. Reconstruction can be done during the same surgery as the mastectomy, but it requires the general and plastic surgeons to share turf and mesh schedules, which may be inconvenient for them — even if it's good for you.

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