How decision-making habits influence the breast cancer treatments women consider

August 15, 2017
Sarah Hawley, Ph.D., MPH. Credit: Michigan Medicine

A new study finds that more than half of women with early stage breast cancer considered an aggressive type of surgery to remove both breasts. The way women generally approach big decisions, combined with their values, impacts what breast cancer treatment they consider, the study also found.

Contralateral prophylactic - a procedure to remove both breasts when occurs in only one breast - has become increasingly popular in recent years, with more than 20 percent of opting for it. For most women, removing the unaffected breast does not improve survival.

To understand what factors are driving this increase, researchers at the University of Michigan Comprehensive Cancer Center asked women how they approach the emotional side of -making - if they often regret their decisions, if they take a more rational or more intuitive approach and how much they want their doctor to tell them what to do.

"The decision-making process is complicated. We found there are a lot of values that come into play," says lead study author Sarah T. Hawley, Ph.D., MPH, professor of internal medicine at Michigan Medicine.

Researchers surveyed 2,362 women newly diagnosed with early stage cancer. Women were asked how strongly they considered prophylactic contralateral mastectomy as a treatment option. They were also asked about their values and their decision-making style.

About 54 percent of women said they considered double mastectomy, with a quarter saying they strongly considered it. Results are published in the journal Cancer.

Women who reported they were worried about making a bad decision were more likely to consider double mastectomy. Those who considered themselves more logical in their decision making considered it less often than those who said they go with their gut.

Of the concerns studied, worry about cancer returning and avoiding radiation exposure were most strongly associated with considering contralateral prophylactic mastectomy.

Reshma Jagsi, M.D., D.Phil., with a patient. Credit: Michigan Medicine

But a more aggressive surgery does not always address those concerns, the researchers note.

"Fears about radiation are common, so it is very important to make sure women are fully informed before they make the decision to pursue much more aggressive surgery than they need," says study author Reshma Jagsi, M.D., D.Phil., professor and deputy chair of radiation oncology at Michigan Medicine.

"We need to make sure women understand how far technology has advanced to make radiation treatment safe and tolerable. We also need to make sure women understand that even after mastectomy radiation might be recommended, if the cancer has certain features," she adds.

In addition, who said they wanted to make their own decisions most of the time, rather than relying on their doctor, more strongly considered double mastectomy. The findings suggest that this more aggressive treatment tends to be driven by patient desire, rather than a physician's recommendation.

"It goes against what the traditional shared decision-making model would suggest, which is when you involve people and inform them fully, most people would be inclined to choose less extensive treatment," Hawley says.

The researchers suggest that physicians and decision aids need to consider patient values during the process. Hawley and colleagues have developed a decision tool that walks patients through an exercise to prioritize their values, mapping those values to potential treatment decisions. They plan to broaden that based on these findings.

"If physicians have feedback that a patient likes to make decisions a certain way, they can understand the patient's emotional processing and help the patient make a decision that meets her needs physically and emotionally," Hawley says.

This could mean educating patients about misperceptions around risk. Many patients overestimate their risk of cancer returning, and they may not understand the impact of . It could also mean simply acknowledging a patient may feel uncomfortable with some treatment recommendations.

"A lot of these conversations around therapy - including extensive therapy that may not be truly beneficial in terms of survival - may come down to emotional values. Physicians need to help patients feel comfortable with treatment decisions within their underlying nature and values. This includes helping patients understand when less extensive might be the right option. Patients need to feel secure in knowing that choice will give them their best chance at survival," Hawley says.

Explore further: Most women who have double mastectomy don't need it, study finds

More information: Sarah T. Hawley et al, The association between patient attitudes and values and the strength of consideration for contralateral prophylactic mastectomy in a population-based sample of breast cancer patients, Cancer (2017). DOI: 10.1002/cncr.30924

Related Stories

Most women who have double mastectomy don't need it, study finds

November 27, 2012
About 70 percent of women who have both breasts removed following a breast cancer diagnosis do so despite a very low risk of facing cancer in the healthy breast, new research from the University of Michigan Comprehensive ...

Study finds substantial rate of contralateral prophylactic mastectomy when procedure not indicated

December 21, 2016
In a survey of women who underwent treatment for early-stage breast cancer in one breast, contralateral prophylactic mastectomy (CPM; both breasts are surgically removed, the breast that contains cancer and the healthy breast) ...

Study finds misperceptions about impact of double mastectomy

June 2, 2015
A survey of women with breast cancer found that nearly half considered having a double mastectomy. But of those who considered it, only 37 percent knew that the more aggressive procedure does not improve survival for women ...

Most women who have double mastectomy don't need it, study says

May 21, 2014
About 70 percent of women who have both breasts removed following a breast cancer diagnosis do so despite a very low risk of facing cancer in the healthy breast, new research from the University of Michigan Comprehensive ...

Different breast cancer treatment options vary widely in their cost-effectiveness

April 10, 2017
A new study published today in the Journal of the National Cancer Institute indicates that different therapies for early-stage breast cancer have very different relative values. Some therapies may have fewer complications ...

Cancer surgeons advise against removal of healthy breast

July 30, 2016
(HealthDay)—Only certain women with cancer in one breast should have their healthy breast removed in an attempt to prevent cancer, a leading group of breast surgeons maintains.

Recommended for you

Brain powered: Increased physical activity among breast cancer survivors boosts cognition

September 19, 2017
It is estimated that up to 75 percent of breast cancer survivors experience problems with cognitive difficulties following treatments, perhaps lasting years. Currently, few science-based options are available to help. In ...

Targeted antibiotic use may help cure chronic myeloid leukaemia

September 19, 2017
The antibiotic tigecycline, when used in combination with current treatment, may hold the key to eradicating chronic myeloid leukaemia (CML) cells, according to new research.

Bone marrow protein a 'magnet' for passing prostate cancer cells

September 19, 2017
Scientists at the University of York have shown that a protein in the bone marrow acts like a 'magnetic docking station' for prostate cancer cells, helping them grow and spread outside of the prostate.

Brain cancer breakthrough could provide better treatment

September 19, 2017
A new discovery about the most common type of childhood brain cancer could transform treatment for young patients by enabling doctors to give the most effective therapies.

Researchers compose guidelines for handling CAR T cell side effects

September 19, 2017
Immune-cell based therapies opening a new frontier for cancer treatment carry unique, potentially lethal side effects that provide a new challenge for oncologists, one addressed by a team led by clinicians at The University ...

A new paradigm for treating transcription factor-driven cancers

September 18, 2017
In the current issue of Proceedings of the National Academy of Sciences, researchers from Nationwide Children's Hospital describe a new paradigm for treating transcription factor-driven cancers. The study focuses on Ewing ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.