The study reviewed here found that half of more than 1,000 women diagnosed with early-stage breast cancer didn't understand how lumpectomy followed by radiation compared to mastectomy in lowering the risk of the cancer coming back. The researchers also found that African American and Hispanic women were less likely than white women to understand how the two surgeries compared, no matter where they received their care.
Most of the women (75%) in this study were told about both types of surgery. The women whose doctors didn't discuss both options with them were much less likely to know how the two surgeries compared.
Women diagnosed with early-stage breast cancer may choose to have a mastectomy instead of lumpectomy and radiation because they think removing all of the breast makes it less likely that the cancer will come back. But research has shown that small early-stage breast cancers (under 4 centimeters) removed by lumpectomy that is then followed by radiation therapy have the same risk of coming back within 5 years as small early-stage cancers removed by mastectomy.
This study suggests that many women make choices about surgery without really understanding how the options compare. This might explain why more women have mastectomy than lumpectomy and radiation therapy in some parts of the United States, even though both choices are usually equally effective.
When you and your doctor are deciding on the best breast cancer treatment plan for you, consider asking your doctor the following questions:
So that you can remember and review what you and your doctor have discussed, you might want to write things down while you're talking with your doctor (or bring a friend to help listen and take notes for you). You also can ask your doctor if you can record the discussion.
Talk to your doctor about all of the assumptions that have been made in choosing the best treatments for you. You also might consider getting a second opinion to see if the treatment plan you've been given is recommended by the second doctor.
Making the most informed decisions about your treatment plan is a shared responsibility between you and your doctor. Ask as many questions as you need to until you're comfortable with your choices. There's only one of YOU and you deserve the best care possible.
NEW YORK (Reuters Health) - Even after undergoing breast cancer surgery, about half of women don't know that survival rates with removal of the cancerous portion of the breast only, along with radiation treatment, are equal to those seen with removal of the entire breast.
African-American and Hispanic women were less likely than whites to have this information, Dr. Sarah T. Hawley of the University of Michigan Health System in Ann Arbor and her colleagues found. Furthermore, this racial disparity in knowledge was the same even among women who received treatment at the highest-quality cancer centers, from the most experienced surgeons.
"We feel like it probably has a lot more to do with the way the providers are communicating information to patients" than with the overall quality of care itself, Hawley noted in an interview with Reuters Health.
Five-year survival rates after breast-conserving surgery (BCS), or lumpectomy, along with radiation for early-stage breast cancer are now known to be the same as those for mastectomy, in which the entire breast is removed, Hawley and her team note in their report in the latest online issue of Health Services Research.
However, the percentage of women who undergo mastectomy for early-stage disease remains high in certain parts of the country, they add. This has "raised concerns that many women may not be fully informed about surgical treatment options."
To investigate, the researchers surveyed 1,132 patients in Detroit and Los Angeles who had already undergone treatment for early-stage breast cancer, along with 277 surgeons.
Overall, 51 percent of the women were aware that five-year survival after BCS with radiation was the same as it was after mastectomy, the investigators report.
Nearly three-quarters of the women surveyed said that their surgeon had discussed both treatment options with them, and these women were more likely to understand that survival rates were the same for both options. In 20 states, including Michigan and California, the researchers note, surgeons are required by law to discuss both treatment options with eligible patients.
Nonetheless, while 57 percent of the white women in the study had survival knowledge, just 34 percent of African-American women and 37 percent of Latinas and women from other ethnic groups did.
"Perhaps the most concerning finding from this analysis was the persistence of racial/ethnic differences in breast cancer treatment knowledge despite controlling for surgeon characteristics, treatment location, and patient-surgeon communication," the researchers write.
Deciding what type of treatment to have can be "overwhelming" for women with breast cancer, Hawley noted, especially when they are under pressure to make that decision quickly. She and her colleagues are now developing tools to help surgeons communicate with breast cancer patients more effectively about their treatment options, and also investigating when in the course of treatment women would prefer to have this discussion.
SOURCE: Health Services Research, online 2008.
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