Let’s discuss new research in the medical journal Breast from doctors at Royal Marsden Hospital UK and Uppsala University Hospital in Sweden.
“Breast surgery remains the original and most effective ‘targeted’ therapy: excision of early cancer is curative and for more advanced disease surgery improves local disease control.
However in well intentioned pursuit of cure and local disease control, some cancers are over-treated (with surgeries that may not be necessary) resulting in major physical and emotional morbidity.
Surgeons can reduce the burden of surgery further but it is important that less surgery is not over-compensated by more radical or unnecessary systemic therapies and/or radiotherapy with their own toxicities and morbidity.
We all need to be alert to the potential drivers of over treatment and over surgery such as failure to work within a multidisciplinary team, failure to design a multimodality treatment plan at diagnosis or overuse of novel assessment technologies of uncertain clinical utility. 1
The doctors in this study are talking to doctors in a valiant attempt to reduce unnecessary breast cancer surgeries but warn not to replace surgery with unnecessary chemotherapy and radiotherapy.
The woman’s role in breast cancer surgery
In a previous study, doctors at the University of Michigan showed:
- The more surgeries that a surgeon performed – less information on alternatives leading to very little patient involvement in the decision making process was found.2 It is difficult to say whether the women in this study wanted to participate or not. If they did, they were not given the chance.
In the medical publication World Journal of Surgery, doctors recommended:
When deciding on a suitable surgical approach for women with early breast cancer, physicians could try to more clearly communicate to the women that they can choose whether or not to participate in the decision-making regarding surgical technique. An important part of patient involvement is sufficient preoperative information.3
However, when women do take the initiative, they opt towards surgery. Especially in mastectomy to remove a NON-cancerous breast.
In a new study entitled: Why Are There So Many Mastectomies in the United States?, doctors at Memorial Sloan Kettering Cancer Center in New York suggests that evidence indicates that increasing use of mastectomy (as a preventative medical procedure) is a patient-driven trend that is most pronounced among younger, educated, and well-insured women, and reflects fear of recurrence and in some cases misunderstanding of future cancer risks.
Although satisfaction levels are generally high among patients choosing mastectomy to remove a non-cancerous breast, complications and procedure extent may be underestimated. Improved communication strategies are essential to facilitate this complex decision-making process.3
We cover the cancer treatment decision making process further in our article Cancer patients want more say in making cancer treatment decisions
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1 MacNeill F, Karakatsanis A. Over surgery in breast cancer. Breast. 2017 Feb;31:284-289. doi: 10.1016/j.breast.2016.10.023. Epub 2016 Nov 25.
2 Hawley ST, Lantz PM, Janz NK, Salem B, Morrow M, Schwartz K, Liu L, Katz SJ. Factors associated with patient involvement in surgical treatment decision making for breast cancer. Patient Educ Couns. 2007 Mar;65(3):387-95. Epub 2006 Dec 6.
3 Mamtani A, Morrow M. Why Are There So Many Mastectomies in the United States? Annu Rev Med. 2017 Jan 14;68:229-241. doi: 10.1146/annurev-med-043015-075227. Epub 2016 Aug 26.