Breast Cancer: Women Often Reject Lumpectomy
Many Opt for Mastectomy When Offered the Choice
Cancer Fears May Drive Decision
Women who chose mastectomy were more likely to be worried about cancer recurrence and they expressed more fears and concerns about radiation treatment, which is done after a lumpectomy.
During a mastectomy the entire breast is removed. In breast-conserving lumpectomy surgery only the tumor and some surrounding tissue are removed; this is followed by radiation therapy.
There is a higher risk of breast cancer recurrence among women who opt for breast-sparing surgery. But these recurrences are usually caught early, and the overall survival rate with lumpectomy plus radiation is comparable to mastectomy.
Katz says about 10% to 15% of breast cancer patients are not good candidates for breast-sparing surgery because their cancer is diffused throughout the breast or for some other reason.
He adds that other patients who could choose lumpectomy but opt for mastectomy instead should not be made to feel that the decision is wrong.
"These are the women who are saying they want a mastectomy because it will allow them to leave their disease behind quicker," he says. "The message to doctors, surgeons, and policy makers is that this is a reasonable choice."
Take Your Time
In an editorial published with the study, Medical College of Wisconsin professor of medicine Ann Nattinger, MD, MPH, noted that many women may not buy the notion that lumpectomy plus radiation is as effective as mastectomy.
"Some patients may have difficulty with the somewhat abstract notion that an irradiated cancer is just as 'gone' as a cancer that has been surgically removed," she wrote.
She tells WebMD that women may also have a hard time believing that a bigger risk of cancer recurrence doesn't translate into poorer survival.
Both Katz and Nattinger stressed the importance of taking time to assess medical options when making decisions about breast cancer treatment. Surgery is often performed as soon as possible after diagnosis, but this is not usually medically necessary, Katz says.
"Biologically, breast cancer treatment is not a medical emergency," he says. "Treatment should be initiated promptly, but weeks don't usually matter. What does matter is getting to the most experienced surgeon and getting the best information you can. This isn't always possible if you are rushed into treatment."
Nattinger agrees but says patients aren't often given this message.
"Women need to know that they usually have the luxury of taking a few weeks or even a month to carefully access their options," she says. "They should feel free to get a second opinion and spend some time making this decision."