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Original contribution: surgeon recommendations and receipt of mastectomy for treatment of breast cancer
JAMA, 10/28/09

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)

Results

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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