Mastectomy decisions among racially and ethnically diverse breast cancer patients

Women diagnosed with nonmetastatic breast cancer who were concerned about body image and their spouse's opinion were less likely to have a mastectomy than those who placed less concern on these issues, according to new study published online August 31 in the Journal of the National Cancer Institute. Overall, patients who were more involved in the decision making about their treatment were more likely to have a mastectomy, regardless of racial or ethnic group. Sarah T. Hawley, Ph.D., MPH, of the Division of General Medicine, Department of Internal Medicine at the University of Michigan in Ann Arbor, Ann Arbor VA Medical Center and Cancer Surveillance and Outcomes Research Team, and colleagues evaluated the association between patient decision involvement and receipt of surgery among racially and ethnically diverse patients, as well as patients' attitudes about surgery and the role of family and friends in treatment choices.

Researchers identified over 3,000 women diagnosed with nonmetastatic breast cancer from June 2005 through February 2007 who were reported to the Los Angeles or Detroit Surveillance, Epidemiology, and End Results registries. The primary factors analyzed in the choice of surgical options were patient involvement in decision making, race or ethnicity, concern about recurrence, the effects of radiation, the impact of surgery on body image, and the role of others in decision making. The response rate to the survey was 72.4%.

Researchers found that patient attitudes about surgery, as well as the opinion of family and friends, contribute to the surgical choices made by women with breast cancer. Greater patient involvement in decision making was associated with greater receipt of mastectomy in all racial and ethnics groups.

Also, women who considered the chance of recurrence or radiation side effects very important were more likely to receive mastectomy initially than those who were less concerned. Those who reported that concern about body image and their spouse's opinion were very important factors in their surgery decision were less likely to receive mastectomy initially than those who were less concerned.

"…given that many patients….reported that they relied on their family or friends for help in decision making, an approach to decision making that involves the patient and her important sources of support may improve the delivery of complex treatment information," the authors write.

Source: Journal of the National Cancer Institute