When in doubt, more women are choosing to go under the knife, opting for mastectomies during early stage breast cancer, even when less invasive treatment options would offer the same odds of survival.
The study, reported in JAMA Surgery by researchers at Vanderbilt University Medical Center and Tennessee Valley Healthcare System, was designed to help cancer experts gain a better understanding of the proportion of women with early-stage breast cancer who opted to have a mastectomy instead of breast conservation surgery — a less invasive treatment option that in many cases offers the same odds of survival.
For the study, researchers looked at data from the National Cancer Data Base on more than 1.2 million women treated for early-stage breast cancer in the United States between Jan. 1, 1998 and Dec. 31, 2011. Researchers found that overall, the percentage of women who underwent mastectomy increased from 34.3 percent in 1998 to 37.8 percent in 2011. Of the women who had mastectomies, the data showed that 45 percent underwent total mastectomy, 34.7 percent had modified radical mastectomy, 19.5 percent had bilateral mastectomy, and 0.8 percent had radical mastectomy.
Younger women were more likely to undergo mastectomy regardless of tumor size, whereas in older women the mastectomy choice appeared to be linked to a tumor size greater than 2 cm. Rates of bilateral mastectomy when the disease was only diagnosed in one breast also increased from 1.9 percent in 1998 to 11.2 percent in 2011.
So more women are having mastectomies than in the past, even when breast conservation surgery has emerged as a viable and less invasive option. But one thing that isn't clear is whether or not this is a choice of the women or their doctors. According to the study, "[L]ess than 50% of women reported being asked by their physicians whether they preferred breast conservation surgery or mastectomy, and more than 80% of women reported that their physicians made a specific recommendation for either breast conservation surgery or mastectomy.”
In an age when the surgeries and other treatment methods are becoming less and less invasive — using ultrasound or laparoscopic instruments instead of the scalpel — researchers were concerned about this trend in breast cancer treatment and hope to use these numbers to better inform doctors and their patients about the treatment choices available.
"Many women are making this decision out of fear and anxiety and not fully understanding the true risks and benefits," Ann Partridge, an oncologist at Dana-Farber Cancer Institute, told The Wall Street Journal. "For most women, the likelihood of a new breast cancer occurring in the other breast is really quite low."
Partridge tells patients there is no right or wrong choice, but she says it's important they know all the risks and benefits.
“I tell women, recognize that you are really treating your anxiety—and we have better ways to manage that.”
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