Mastectomy Not First Choice for Most Breast Cancer Patients

Oct. 14 -- TUESDAY, Oct. 13 (HealthDay News) -- Contrary to common belief, most women diagnosed with breast cancer are not turning to mastectomy as their first choice for treatment but are first trying more conservative approaches, such as lumpectomy, a new survey has found.

The survey, reported in the Oct. 14 issue of the Journal of the American Medical Association, also found that U.S. doctors are doing a good job of presenting newly diagnosed breast cancer patients with a range of treatment options.

The researchers found that those women who did opt for mastectomy instead of breast-conserving surgery often did so because of their own preference and probably because of the perception that mastectomy offered better odds against the cancer coming back.

However, "the chances of surviving breast cancer are the same whether you have a lumpectomy or a mastectomy," noted the study's lead author, Dr. Monica Morrow, chief of the breast service and chairwoman of clinical oncology at Memorial Sloan-Kettering Cancer Center in New York City.

"There's an overwhelming feeling that somehow 'bigger' surgery is better surgery," Morrow said. "It's something I hear over and over again: 'I want to be safe so I will have the mastectomy.' "

The researchers wrote in their report that they undertook the study because there's been a perception that women have been given mastectomies unnecessarily, when breast-conserving surgery might have been an option.

The team reviewed data from the U.S. National Cancer Institute's Surveillance, Epidemiology and End Results registries in Los Angeles and Detroit. They included data on 1,984 women with intraductal, stage 1 or stage 2 breast cancer who completed a telephone survey about their experience with cancer surgery.

The women, 20 to 79 years old, included 953 women who listed their race as white or other, 502 Hispanic women and 529 black women.

Most of the women -- 75 percent -- chose breast-conserving surgery initially. According to Morrow, some women who chose breast-conserving surgery eventually had a mastectomy, and these were typically women with larger, stage 2 tumors. The choice did not appear to be affected by race, education or where a woman was treated, Morrow noted.

Of those who initially underwent mastectomy, many could identify the reason that mastectomy was the best option for them, suggesting that it was something discussed in detail with their doctor.

Almost 9 percent of the women chose to have a mastectomy because of personal preference.

Nearly one in five women sought a second opinion, and women with higher education levels were more likely to do so. But, regardless of education level, the researchers found that getting a second opinion was rarely a deciding factor in choosing the type of treatment.

"Most of the time, a second opinion didn't make a difference in the recommendations that a woman is offered," she said. "So if you feel comfortable with your surgeon, don't feel obligated to seek a second opinion."

Additional surgery was required in about 38 percent of women who first underwent a lumpectomy, according to the survey.

"This study addresses the concern that mastectomy is overused, and I really don't think it's being overused," said Dr. Nora Jaskowiak, an associate professor of surgery and the surgical head of the University of Chicago Breast Center. "Surgeons definitely try to save as many breasts as is reasonable to do."

"Patients and surgeons can discuss the options, and together they will make the best decision for that woman," she said.

More information

The U.S. National Research Center for Women and Families has more about surgical options for early-stage breast cancer.

SOURCES: Monica Morrow, M.D., chief, Breast Service, Department of Surgery, and Anne Burnett Windfohr chair, clinical oncology, Memorial Sloan-Kettering Cancer Center, New York City; Nora Jaskowiak, M.D., associate professor, surgery, University of Chicago Medical Center, and surgical head, University of Chicago Breast Center, Chicago; Oct. 14, 2009, Journal of the American Medical Association