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