Surgeons have major influence on breast cancer treatment

September 13, 2017, University of Michigan
breast cancer
Mammograms showing a normal breast (left) and a breast with cancer (right). Credit: Public Domain

A woman's choice of surgeon plays a significant role in whether she's likely to receive an increasingly popular aggressive breast cancer surgery.

The procedure, called contralateral prophylactic mastectomy or CPM, involves removing both breasts even when is found only in one. It is seen to be strongly driven by ' preferences.

A new study, published in JAMA Surgery, finds that surgeons had the strongest influence on the likelihood of a woman having CPM.

Surgeons have huge influence on treatment, and with that comes ultimate responsibility to get it right with patients, even with a procedure that seems to be driven largely by patient preference," says senior study author Steven J. Katz, M.D., MPH, professor of medicine and of health management and policy at the University of Michigan.

Researchers surveyed 3,353 women with early stage breast cancer and matched them to 349 surgeons, who were also surveyed. About 16 percent of the women reported receiving CPM.

Surgeons were asked to assess a typical patient scenario and indicate what kind of treatment they would recommend. From there, the researchers categorized surgeons based on most to least likely to favor breast conservation.

Surgeons also indicated whether they would perform contralateral prophylactic mastectomy if the patient requested it. Responses were categorized based on most to least likely to perform CPM.

The researchers found the surgeon's attitudes had a large impact on whether the patient received CPM.

"Two attitudes seem to explain the difference: How strongly the surgeon favors breast conserving surgery and how reluctant the surgeon is to perform CPM," Katz says.

For surgeons who heavily favored breast conserving surgery and were most reluctant to perform CPM, only 4 percent of their patients had CPM. For surgeons who least favored conservation and were most willing to do CMP, the rate was 34 percent.

"That difference is huge. Even for a procedure that is very patient-driven, we see that surgeons account for a lot of the variability in the community and those surgeon attitudes really matter in terms of whether a patient does or does not get CPM," Katz says.

The three most common reasons reported for performing double mastectomy if the patient requested it were to give patients peace of mind, avoid conflict and improve cosmetic outcomes.

For most women with early stage breast cancer in one breast, removing the unaffected breast does not improve survival. Many experts question whether CPM in these women is overtreatment.

"More extensive treatment than is needed equals more harm and more side effects. There's a sea change going on among cancer doctors who increasingly recognize potential overtreatment and strive to reduce it," says study author Monica Morrow, M.D., chief of the service at Memorial Sloan Kettering Cancer Center.

"If a patient does not feel 100 percent confident with what their doctor is discussing and recommending, they should seek a second opinion," Katz adds.

Explore further: When the doctor recommends against the surgery a breast cancer patient wants

More information: JAMA Surgery (2017). DOI: 10.1001/jamasurg/2017.3415

Related Stories

When the doctor recommends against the surgery a breast cancer patient wants

April 5, 2017
More women with breast cancer are electing to have both breasts removed, even when cancer affects only one breast. The procedure, called contralateral prophylactic mastectomy (CPM), is a more complex surgery that has not ...

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 ...

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

August 15, 2017
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 ...

Surgical options after a cancer diagnosis in one breast

November 9, 2016
Dear Mayo Clinic: My daughter was diagnosed with breast cancer at 54 and had surgery to remove one breast. Her surgeon told her that it wasn't necessary to remove both breasts, because she was not at high risk for developing ...

Recommended for you

Researchers use a molecular Trojan horse to deliver chemotherapeutic drug to cancer cells

February 23, 2018
A research team at the University of California, Riverside has discovered a way for chemotherapy drug paclitaxel to target migrating, or circulating, cancer cells, which are responsible for the development of tumor metastases.

Study tracks evolutionary transition to destructive cancer

February 23, 2018
Evolution describes how all living forms cope with challenges in their environment, as they struggle to persevere against formidable odds. Mutation and selective pressure—cornerstones of Darwin's theory—are the means ...

Lab-grown 'mini tumours' could personalise cancer treatment

February 23, 2018
Testing cancer drugs on miniature replicas of a patient's tumour could help doctors tailor treatment, according to new research.

An under-the-radar immune cell shows potential in fight against cancer

February 23, 2018
One of the rarest of immune cells, unknown to scientists a decade ago, might prove to be a potent weapon in stopping cancer from spreading in the body, according to new research from the University of British Columbia.

Putting black skin cancer to sleep—for good

February 22, 2018
An international research team has succeeded in stopping the growth of malignant melanoma by reactivating a protective mechanism that prevents tumor cells from dividing. The team used chemical agents to block the enzymes ...

Cancer risk associated with key epigenetic changes occurring through normal aging process

February 22, 2018
Some scientists have hypothesized that tumor-promoting changes in cells during cancer development—particularly an epigenetic change involving DNA methylation—arise from rogue cells escaping a natural cell deterioration ...

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.