Why 1 in 4 Early-Stage Breast Cancer Patients Still Opt for Mastectomies

Sometimes doctors are to blame, but often women get a breast removed against medical advice.

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For more than 20 years, breast cancer patients have been overtreated with mastectomies, experts contend, instead of with breast-sparing surgery that removes just the lump and a little of the surrounding tissue. The good news is about 75 percent of women who qualify for breast-conserving surgery are getting it, according to a survey of 2,000 women published in today's Journal of the American Medical Association.

The study found that for those who still opted for total breast removal, the decision was sometimes based on a surgeon's recommendation and sometimes against medical advice. In fact, nearly 9 percent of breast cancer patients opted to get a mastectomy when their doctors didn't state a preference either way or when their doctors actually urged them to get breast-conserving surgery. "Our findings suggest that patient preferences play an important role in initial receipt of mastectomy, especially in the absence of a surgeon recommendation favoring one procedure over another," wrote the study's authors.

The survey identified the most common reasons why women were opting for mastectomies. Many didn't want to deal with radiation treatments, routinely given after lumpectomies to prevent local recurrence. Others wanted peace of mind that all of their cancer was removed, but often were unaware that survival rates for the two surgeries are the same for early stage breast cancer. (Neither surgery guarantees that the cancer hasn't already spread.)

At a news conference announcing the study, lead author Monica Morrow, a breast surgeon at Memorial Sloan-Kettering Cancer Center, said doctors need to do a better job of communicating information about survival rates. "Fewer than 50 percent of women who chose to have mastectomies recalled 6 months later that survival rates for the two surgeries are equal," she said—which means that if women were indeed told this information by their surgeons, it didn't sink in. Surgeons also need to make more of an effort, she said, to shrink larger tumors with chemotherapy administered before surgery to enable more women to avoid mastectomies. Research shows there's no survival difference if surgery is delayed to administer chemo, yet many doctors are reluctant to employ this approach, perhaps because it's relatively new.

I'm also wondering if more women would opt for breast-sparing surgery if they knew how harrowing breast reconstruction can be. A former colleague of mine, a physician, told me that the most painful part of his wife's recovery from breast cancer was her reconstruction surgery. And a close friend who needed a mastectomy to remove a fairly large tumor recently needed several surgeries to reconstruct her new breast. I'm sure she would have jumped at breast-conserving surgery if she'd been a candidate.

Check it out: The New York Times ran a disturbing piece yesterday on the price of fertility treatments—in terms of health problems associated with multiple births. And AOL's That's Fit blog has an interesting column on running with your romantic partner. I run occasionally with my husband and relish the uninterrupted conversation, but this column cites a host of other motivating factors.