NEW YORK (Reuters Health) - Women with breast cancer faced with treatment decisions are often not told by their surgeons about the possibility of breast reconstruction after a mastectomy, a study confirms. When these conversations do occur, many more women choose mastectomy, researchers found.
In a survey of 1,178 women who had breast cancer surgery, only 33 percent reported that their surgeon had discussed breast reconstruction with them during the surgical decision-making process.
"We found it surprising that very few patients were informed about their options for breast reconstruction, and that information regarding reconstruction was more likely to be given to younger women who were more educated," Dr. Amy K. Alderman of the University of Michigan Medical Center, Ann Arbor, told Reuters Health.
The survey, posted online Friday by the medical journal Cancer, also indicates that women who had these discussions with their surgeon were four times more likely to have a mastectomy compared to women who did not discuss reconstruction.
"Women need to be fully informed about all of their surgical options for breast cancer: lumpectomy, mastectomy and mastectomy with reconstruction," Alderman said. "All are great options with the same long-term survival."
Breast reconstruction, continued Alderman, "is a personal decision for each woman that is influenced by her body image, sexuality, fear of recurrence, etc. Women should be educated consumers of their healthcare."
She concluded: "We, as physicians, need to make sure that all women, regardless of the patients' education and socioeconomic status, are fully informed of their surgical choices for breast cancer care."
SOURCE: Cancer, February 1, 2008, online December 21, 2007.
Only about a third of the almost 1,200 women in the study reviewed here talked about reconstruction with their surgeons when making decisions about breast cancer surgery. But the women who did talk about reconstruction were 4 times more likely to choose mastectomy over lumpectomy (breast-conserving surgery).
Reconstruction was more likely to be discussed with younger, more educated women who were diagnosed with larger cancers. It's possible that women with more education may do more to learn about their options for surgery and may be the ones to bring up the topic of reconstruction.
While not mentioned in this article, it's important to know that the women in the study were all from either Detroit or Los Angeles -- 2 large cities. So these results may not be a snapshot of what is happening in the whole United States. Also, this study was a retrospective study. This means that the researchers contacted the women after they had recovered from the surgery and asked them to remember what they talked about with their surgeons. In a study like this, people sometimes don't accurately remember everything that happened.
For women diagnosed with a cancer smaller than 4 centimeters that was removed with clear margins (no cancer cells were found in the tissue surrounding the cancer), lumpectomy followed by radiation therapy is likely to be equally as effective as mastectomy. Although most women who have a choice prefer the less invasive lumpectomy, the choice depends on many factors, including:
About 75% of women who have mastectomies go on to have breast reconstruction. If you're considering mastectomy as an alternative to lumpectomy and radiation, you and your doctor also should discuss breast reconstruction. Even if you are leaning toward lumpectomy and radiation, it's important to talk to your doctor about reconstruction while considering your options. Some women have breast reconstruction after lumpectomy to restore balance to the size and contour of their breasts.
For more information on the timing and types of breast reconstruction, visit the breastcancer.org Reconstruction section.
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