Breast cancer patients are not getting all the information they need to make educated treatment decisions. A new study—paid for by the National Cancer Institute—revealed most doctors don’t discuss breast reconstruction options with women prior to cancer surgery, depriving them of key information that can impact whether to have an entire breast or just a lump removed. One-third of the 1,178 women in the study—surveyed three months after surgery from 2001 to 2003—said surgeons discussed cosmetic remedies with them in advance. Two-thirds said reconstruction never came up with general surgeons before surgery. Younger and more educated women were more likely to discuss reconstruction options. The question of who initiated the topic—patient or doctor—was not asked. Women who see breast specialists rather than general surgeons may be more apt to receive plastic surgery consultations. Dr. Sameer Patel, a reconstructive surgeon at the Fox Chase Cancer Center in Philadelphia, said some doctors are too focused on the medical part of the decision about what operation to have. “They’re trying to take care of the cancer, and that (cosmetic impact) takes a back seat,” he said.
When the topic was discussed, women were four times more likely to choose mastectomy, possibly because of the reconstruction options, which include implants not available for correcting defects left following lumpectomies; however, mastectomies can be a suspicious choice since breast-conserving lumpectomies generally suffice. When cancer has not widely spread, most women opt for lumpectomy; however, some patients need or prefer mastectomy. Breast cancer is the most common major cancer in American women with over 178,000 new cases expected this year in the U.S. and over 1 million worldwide. ”Our point is not to say that one decision is better than another, but that women need to know all their options,” said Dr. Amy Alderman, the University of Michigan plastic surgeon who led the study. “There are positives and negatives to both. We shouldn’t be paternalistic and tell patients, ‘This is what you need.’” Dr. H. Kim Lyerly, a breast surgeon and director of Duke University’s Comprehensive Cancer Center, agreed. The study is the second recent report to call attention to the often-neglected cosmetic consequences of cancer surgery. Studies at last week’s San Antonio Breast Cancer Symposium also discussed limited options for millions left with dimpled or cratered breasts following lumpectomies. Doctors say the latest study, conducted in over 100 hospitals in Detroit and Los Angeles, may overstate the doctor-patient communication problem, but acknowledge that one exists.
Debbie Horwitz encountered that attitude three years ago when she found a cancerous lump. Her mother died of breast cancer and her grandmother had the disease, so when tests showed she had a mutated gene raising her risk of future tumors, she had a double mastectomy. “I was really frustrated to find out there were no process pictures of what the reconstruction process would be like,” she said. “It’s a months-long process. There were a lot of before and after pictures, but there’s a lot that happens in between. If you were going to take off somebody’s arm, or a leg had to be amputated, you would talk to them about prosthetics. I don’t understand how doctors can leave that part out.”
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