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Half of Surgeons Would Choose Mastectomy Over Lumpectomy -- If They Had Breast Cancer


WebMD Health News

Nov. 16, 1999 (New York) -- Given the choice between mastectomy and lumpectomy -- surgery to remove the cancer but keep (conserve) the breast -- if they had early-stage breast cancer, 50% of surgeons would opt for mastectomy. This surprising finding, from a recent survey of practicing surgeons, challenges the widely held belief that breast-conserving surgery is the best option for almost everyone. The results of the survey of 26 male and 16 female surgeons were reported in a recent a issue of Effective Clinical Practice.

"Our results argue against the notion that ... [breast-conserving surgery] is always the right choice for the treatment of early-stage breast cancer," write E. Dale Collins, MD, and fellow researchers from the Dartmouth-Hitchcock Medical Center in Lebanon, N.H., where the survey was conducted. "Even informed, medically sophisticated decision makers differ markedly in their own preferences."

The point, Collins tells WebMD, is that such a choice "involves many personal factors."

Lumpectomy, or breast-conserving surgery, is a well-accepted alternative to mastectomy for most women with early-stage cancer. But many experts believe it is used less often than it should be -- based on the continued high rates of mastectomy -- possibly because women are unaware of other options. Other experts say more mastectomies are done because the physician?s recommendation supersedes the patient?s preference.

Eva Singletary, MD, tells WebMD that the study is important because it shows that even though a woman may be a good candidate for breast conservation, her choice is based on more than just one issue and she should not be made to feel guilty, regardless of her choice.

"[All] treatment options should be discussed, and one should not assume that the patient would want to have breast conservation," says Singletary, who was not involved in the survey. "The other thing that I think is influencing this survey is that in the past we really did not have good breast reconstruction available. So if you had your choice of saving the breast or having no breast, you would choose to save the breast."

Singletary is chief of surgical breast services at the M.D. Anderson Cancer Center in Houston. She says the choices made by the surgeons in the survey are nearly identical to the choices actually made by women facing this decision.

Talking with other patients and watching interactive videos of actual patients can help women in the decision-making process, Singletary says, but one of the most important factors -- often overlooked -- is time. "It's important for women facing this decision to know that they don't have to have surgery before the sun goes down. Most women, given some time, can make a decision that they feel comfortable with."

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