Are Breast Cancer Patients
Given Accurate Information
About their Options?
By Diana Zuckerman, Ph.D.
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.
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.
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.
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.
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.
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
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.
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
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.
article is based on "The Need for Improved Informed
Consent for Breast Cancer Patients", published in the
fall 2000 issue of the Journal of the American Medical Women's
National Center for Policy Research for Women & Families
is a non-profit, non-partisan organization that works to
improve the health and well-being of women and families.
The Center gathers, analyzes and translates research-based
information for the public, media and policy makers in order
to encourage new, more effective programs and policies.