Diana Zuckerman, PhD, National Center for Health Research: February 2008
It is shocking but true: approximately one out of every two American women who have a breast removed as treatment for cancer do not need such radical surgery. Whether a woman undergoes a mastectomy or a lumpectomy (which removes the cancer but not the breast) depends less on her specific diagnosis than on other factors, such as where she lives, her income and health insurance, where she receives medical care, her age, and when her doctor was trained.
Although it’s been known for years that lumpectomy and other breast-saving surgeries are just as effective as mastectomy for patients in the early stages of breast cancer, in most parts of the country most of the women who receive an early-stage diagnosis will undergo the more radical and disfiguring surgery. Limited information and biased recommendations are undermining breast cancer patients’ choices.
Articles published in some of America’s most prestigious journals show that many of the more than 182,000 women who are newly diagnosed with breast cancer every year do not have access to all the information they need to make the treatment choices that are best for them. This raises questions about what doctors know and what they are telling their patients.
In addition, mastectomy is often followed by “reconstructive” breast surgery that involves the use of synthetic breast implants or tissue transfers from other parts of the body. These reconstructive surgeries have risks, but the lack of published epidemiological studies means that many of the women making these decisions have limited information about their safety.
After all the research that has been done on the safety of lumpectomies, why are so many women undergoing mastectomies they don’t need and then having reconstruction that can cause serious problems? One reason may be economic. In many facilities, it’s actually cheaper to remove a breast than it is to perform a lumpectomy and provide the necessary follow-up radiation therapy.
Some striking research findings include:
• In some hospitals, all breast cancer patients had mastectomies, regardless of their diagnosis. In one large urban hospital serving mostly poor women in Texas, 84% of the women with early stage breast cancer had mastectomies and only 16% had lumpectomies.
• In a study of 157 hospitals, patients treated by doctors trained before 1981 were less likely to have lumpectomies or other breast-saving surgery than women who had younger doctors.
• One study indicated that women getting mastectomies were more likely to have followed their doctors’ recommendations, but women getting lumpectomies were more likely to have obtained a second opinion, and felt more actively involved in making the decision.
• A study of 175 surgeons found that even doctors who know that lumpectomy is as safe as mastectomy may persuade their patients to get mastectomies by making subtly biased recommendations. Other studies showed that some women were not even told that lumpectomies were an option.
Women deserve better. Breast cancer patients should make the choices that are best for them, wherever they live and no matter how affluent they are. We need to do a better job of making sure that all doctors and their patients have accurate, unbiased information so that women can make those choices, no matter who they are, or who provides their medical care.
The National Center for Health Research is an independent, nonprofit think tank in Washington, DC, which “translates” medical and scientific information into news that can be used by consumers, policy makers, and the media. Contact us for more information or visit our Web site at www.center4research.org.
All articles are reviewed and approved by Diana Zuckerman, PhD, and other senior staff.