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Can You Trust Your Mammogram?

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Surgical Biases continued...

The news: Clinical guidelines developed by leading organizations favor breast-conserving surgery because it's less drastic. That's true whether you live in Augusta, ME, or Augusta, GA. Yet a review of 800,000 patient records found that while 70% in the Northeast had breast-sparing surgery, only 58% of those in the South did (the numbers for the West and Midwest were 63 percent and 61 percent, respectively). The review didn't look for a why, but study leader Jack Sariego, M.D., professor of surgery at Temple University, notes that the more rural South likely has fewer radiation facilities and fewer academic medical centers to promote surgical advances.

Beyond your zip code, the type of surgeon and hospital you choose may affect the recommendation you'll receive. Doctors who treat a lot of breast cancer or who work in cancer centers or academic medical centers suggest lumpectomy more often than general surgeons in the community. Surgeons trained after 1981 are also more likely to recommend a lumpectomy than older doctors, past research from the University of North Carolina at Chapel Hill has shown.

Why it matters: In a survey of 1,132 women who had either a lumpectomy or a mastectomy, almost half indicated they did not understand the risks and benefits of their choice.

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.

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