Information gap may skew mastectomy decisions

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Women with early-stage breast cancer often lacked knowledge about their disease and were not asked their preference regarding surgery, according to recent survey findings.

In order to evaluate the quality of decisions about surgery for early-stage breast cancer, a team led by Clara N. Lee, MD, MPP, the director of surgical research at the University of North Carolina School of Medicine in Chapel Hill, mailed surveys to survivors of stage I/II breast cancer who had been treated at one of four academic medical centers in Chapel Hill; Boston, Massachusetts; and San Francisco, California. The surveys measured patient knowledge, concordance between goals and treatments, and involvement in decisions.

The 440 respondents answered about half the survey questions correctly (mean overall knowledge score was 52.7%). Less than half the women (45.9%) knew that local recurrence risk is higher after breast conservation compared with mastectomy, and just slightly more than half (55.7%) knew that survival is equivalent for the two options.

Although most of the participants (89.0%) stated that they had treatment concordant with their goals, only 48.6% reported that their surgeon asked them about their preference regarding surgical treatment. Women preferring mastectomy were less likely to have treatment concordant with their goals (80.5%) than did women preferring partial mastectomy (92.6%). The respondents reported more frequent discussions of partial mastectomy and its advantages than of mastectomy.

These findings indicate that improvements in the quality of decisions about breast cancer surgery are needed, wrote Lee and colleagues in Journal of the American College of Surgeons (2012;214[1]:1-10), noting that this will require interventions to enhance patient knowledge and incorporate preferences into the decision-making process.

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