|
 The decision to go ahead with the procedure may depend more on the
surgeon’s preferences than on the patient’s, researchers say.
“The majority of patients strongly defer to their surgeons - perhaps
because of the complexity of the treatment choices and clinical
information,” Dr. Steven Katz of the University of Michigan in Ann
Arbor said in an email to Reuters Health.
Katz and colleagues studied survey responses from women diagnosed
with early-stage breast cancer in one breast. Among the 3,353 women
(mean age, 62) who participated in the survey, 16% had the other
breast removed as a preventive measure - a procedure called
contralateral prophylactic mastectomy (CPM).
Researchers also surveyed 349 of the patients’ surgeons, to gauge
their attitudes toward CPM versus breast-conserving surgery, which
involves removing just the cancerous tissue, or surgery to remove
only the affected breast.
Medical guidelines generally recommend against CPM because it
doesn’t improve survival – except possibly for women with certain
genetic mutations that increase their risk for breast cancer and
other malignancies - and it increases the risk for surgical
complications.
Surgeons were given a hypothetical case - a woman with a normal
mammogram, no family history of breast cancer, and a small mass in
one breast - and asked what treatment they would recommend. They
were also asked if they would perform CPM if a woman requested it.
It turned out that surgeons’ attitudes were strongly linked with
whether or not their patients received CPM, according to the report
published in JAMA Surgery.
When surgeons heavily favored breast-conserving surgery and were
most reluctant to perform CPM, only 4 percent of their patients
actually received CPM.
In contrast, 34 percent of women whose surgeons didn’t favor breast
conservation and who were most willing to do CPM had the procedure
done.
The most common reasons surgeons gave for performing CPM, according
to the survey, were to give patients peace of mind, to avoid patient
conflict and to improve cosmetic outcomes. The least frequent
reasons were to avoid losing the patient or to improve survival.
[to top of second column] |
Katz offered tips for women with early-stage breast cancer who want
to explore all of their treatment options:
1- Ask your surgeon’s opinion about the best options and why, and
discuss benefits and harms.
2- Bring someone with you on the first visit to take notes and help
with questions.
3- Ask the surgeon to briefly summarize his or her recommendations
while you record them on your cell phone so you can review them
later. Even if you feel you’ve made a decision on the first visit,
go back for a second visit or discuss again by phone before
finalizing.
“Both patients and physicians have inherent biases when discussing
the options for breast cancer surgical therapy,” Dr. Julie
Margenthaler of the University of Washington School of Medicine in
St. Louis told Reuters Health in an email.
The treatment decision “can be very difficult and is a very personal
one,” said Margenthaler, coauthor of an editorial that was published
along with the study. Discuss options thoroughly, she advises, so
you can make “an informed decision that meets your goals and
values.”
Katz added, “Surgeons want to get this right with patients, and
realize it’s not just only about surgery - it’s about all the
treatments on the table, including radiation, endocrine therapy,
chemotherapy.”
“Slow the decision process down if you need to,” he said. “If you’re
uncertain, a good surgeon will be happy to arrange a second
opinion.”
SOURCE: http://bit.ly/2y3OIEs and http://bit.ly/2y4bRXn JAMA
Surgery, online September 13, 2017.
[© 2017 Thomson Reuters. All rights
reserved.] Copyright 2017 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
 |
