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See Latest ArticlesOriginal contribution: surgeon recommendations and receipt of mastectomy for treatment of breast cancer
JAMA, 10/14/09
Marrow M et al. – Breast-conserving surgery was recommended by surgeons and attempted in the majority of patients evaluated, with surgeon recommendation, patient decision, and failure of BCS all contributing to the mastectomy rate.
Methods- Survey of women aged 20 to 79 years with intraductal or stage I and II breast cancer diagnosed between June 2005 and February 2007
- Patients identified using rapid case ascertainment
- Latinas and blacks oversampled
- Of 3133 patients sent surveys, 2290 responded (73.1%)
- Mailed survey completed by 96.5% of respondents and 3.5% completed telephone survey
- Final sample included 1984 female patients (502 Latinas, 529 blacks, and 953 non-Hispanic white or other)
- Of 1984 patients, 1468 had BCS as initial surgical therapy (75.4%) and 460 had initial mastectomy (including 13.4% following surgeon recommendation and 8.8% based on patient preference)
- Approximately 20% of patients (n = 378) sought second opinion; this was more common for those patients advised by their initial surgeon to undergo mastectomy
- Discordance in treatment recommendations between surgeons occurred in 12.1% (n = 43) of second opinions and did not differ on basis of patient race/ethnicity, education, or geographic site
- Among 1459 women for whom BCS attempted, additional surgery was required in 37.9% of patients, including 358 reexcision (26.0%) and 167 mastectomy (11.9%)
- Mastectomy most common in patients with stage II cancer
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