Breast Cancer: Know the Surgery Options
Study Shows Many Patients Aren't Told About Breast Reconstruction
Dec. 21, 2007 -- Most women facing breast cancer surgery are not
told that mastectomy with breast reconstruction is an option, a new study
Researchers surveyed almost 1,200 early-stage breast cancer patients eligible for
breast-conserving lumpectomy or mastectomy.
They found that only one in three were told by their general surgeon that
breast reconstruction was an option.
Patients who did have the discussion with their surgeon were four times more
likely to choose breast removal over lumpectomy.
Studies show that survival rates are the same among early-stage breast
cancer patients, whether they have breast-conserving surgery with radiation or
Plastic surgeon Amy Alderman, MD, who led the study team, says women need to
be fully informed of their surgical choices before they decide on a treatment
"The point is we have three great surgical choices -- lumpectomy,
mastectomy, and mastectomy with reconstruction," she says. "There are
pros and cons to each of these choices, and we as physicians have a
responsibility to help patients understand this."
Alderman says mastectomy with breast reconstruction often results in better
cosmetic outcomes than breast-conservation surgery.
"I see a lot of patients who are quite unhappy with their cosmetic
appearance after the lumpectomy and I can't do anything about it after they
have had radiation," she says.
The women included in the University of Michigan Medical Center study all
had surgery for stage I, stage II, or stage III breast cancer around 2002.
Only 33% said they discussed breast reconstruction with their general
surgeon during the initial surgical decision-making process.
Younger patients and more highly educated patients were more likely to be
told about breast reconstruction.
Female surgeons and those who worked in cancer centers were the most likely
to discuss mastectomy with breast reconstruction, says Alderman.
The study will be published in the Feb. 1, 2008 issue of the journal
Presenting the Options
Oncologist Otis Brawley, MD, tells WebMD that cancer specialists may be
better equipped than general surgeons to present all the options to breast
Brawley serves as chief medical officer for the American Cancer Society and
is a professor of oncology and hematology at Emory University in Atlanta.
"A general surgeon may do one breast cancer surgery a month, and is
probably less likely to have a relationship with a plastic surgeon," he
Brawley says the study shows that women who are fully informed about their
surgical options may not always chose breast- conserving lumpectomies.
Mastectomy with reconstruction may be the best option for women who want to
avoid radiation and for those who fear that anything less than total breast
removal will increase the chances that their cancer will recur.
"It is important that [mastectomy with] reconstruction not be forced on
anyone, but women facing this decision need to know about it," he says.
But he isn't optimistic that the new study will lead to major changes.
"One paper usually doesn't change medical practice, but I hope it will
alert women with breast cancer, breast cancer support groups, and internists
who take care of women with breast cancer to this issue," he says.