Are mastectomies performed too early?

By Britney Glaser - bio | email
Report by JAMA

LAKE CHARLES, LA (KPLC) - Concerns exist that in the treatment of breast cancer, mastectomies are too often used when breast-conserving surgery might serve the patient just as well.  Now, new research shows those concerns may be unfounded.

Denise Moscatiello was diagnosed with breast cancer in February and immediately assumed she would need major surgical treatment.  "When I got the phone call with the news, which came from the radiologist originally, that's the first thing that pops into your head is 'oh my God, I'm going to need a mastectomy,'" says Denise.

Concerns exist over whether mastectomies are too often performed when a less invasive breast-conserving surgery would suffice.  Dr. Monica Morrow with Memorial Sloan-Kettering Cancer Center says, "Most women would prefer to keep their breast if that option was open to them but over time it's turned out that mastectomy has persisted in the United States as a treatment which raised concerns about whether or not surgeons were even offering a choice in treatment."

Dr. Morrow led research aimed at addressing those concerns, surveying 2,000 women with early stage breast cancer about their choice of initial surgical treatment. It was found that most patients received the procedure recommended by their surgeons and that over 75% reported having breast-conserving surgery as an initial surgical therapy instead of a mastectomy.  "I think the message is that surgeons pretty reliably recognize which women are best treated by mastectomy and that if you're advised to undergo breast-conserving surgery, or you're offered a choice, the lesser surgical procedure is one which is highly likely to work and provide a good outcome," says Dr. Morrow.

After two surgeons recommended it, Denise ended up having breast-conserving surgery.  "I didn't really feel like I was gonna benefit by doing it the other way," she adds.

This study, published this month in JAMA, found that breast-conserving surgery is recommended for most women with early-stage breast cancer. The researchers also found that second opinions did not vary much from the original surgeon's recommendation.

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