Posted on: October 1, 2008

In the Know

Study shows breast cancer patients, particularly minorities, are unclear on treatment outcomes

By Jessica Abels
CTW Features

For women treated for breast cancer, the odds of being alive after five years are roughly the same whether they undergo mastectomy or breast--conserving surgery. And while that's old news, a new study from the University of Michigan Comprehensive Cancer Center indicates that only 49 percent of treated women were in the know. Worse, only 34 percent of African-Americans and 37 percent of Latinas were aware of the survival odds.

"It's important for women to be able to do what we call a high-quality decision-making process," says Sarah Hawley, Ph.D., who authored the study. "That would mean that the decision needs to be well-informed, based on an accurate knowledge of the risks and benefits of the options, and it also needs to be based on their preferences. If women do not make an informed decision, they're more likely to be dissatisfied down the road with the treatment they received."

Researchers surveyed 1,132 women recently diagnosed with breast cancer in the Detroit and Los Angeles metropolitan areas, asking them whether the chances of being alive five years after surgery were the same after a mastectomy or after lumpectomy with radiation, as well as whether the chance of breast cancer returning after treatment was the same for the two treatments. Neither the type of treatment facility the women visited nor the type of surgeon women saw affected the responses, but researchers did find that patients whose surgeons described both treatment options had more adequate knowledge.

An Exit for the Self-Exam?

That monthly self-breast examination may not be as beneficial as researchers once thought

If a self-breast examination is a part of your monthly routine, according to researchers at the Nordic Cochrane Centre, Denmark, you may be doing more harm than good.

In a review of recent studies, Jan Peter Kosters, Ph.D. and Peter Gotzsche, Ph.D. found that the practice of self-exams led to almost twice as many biopsies that turned up no cancer in women who performed them, compared to women who did not. Further, there was no significant difference in breast cancer deaths between the two groups.

"We are advising that women should be aware of what is normal for how their breasts looked and felt, and to promptly report any changes to their health care provider," said Debbie Saslow, Ph.D., director of breast and gynecologic cancers for the American Cancer Society.

In light of earlier evidence that supports the current findings, the association stopped recommending self-exams five years ago, instead describing the monthly evaluations as "an option." "Women who want to should keep doing breast self-exam, and women who don't want to, don't need to," Saslow says.

The review's authors recognize that some women will want to continue with breast self-exams and women should always "seek medical advice if they detect any change in their breasts that might be breast cancer," Kosters says. "We suggest that the lack of supporting evidence...should be discussed with these women to enable them to make an informed decision."

Great Expectations

For breast cancer patients, breast-conserving surgery may leave unrealistic ideas of aesthetic outcome

It's an incredibly hard decision: Women diagnosed with breast cancer often have the choice to undergo mastectomy, removing the entire breast, or breast-conserving surgery, in which only the tumor and surrounding tissue are removed. Now, according to researchers at the University of Michigan Comprehensive Cancer Center, studies show the choice plays a major role in post-operative mental health as well.

In a survey of 714 women who underwent breast-conserving surgery at the University of Michigan Health System, nearly one-third of women reported pronounced asymmetry between their breasts, which made them twice as likely to fear their cancer recurring. Additionally, beast-conserving surgery patients were more likely to display symptoms of depression, perceive themselves as less healthy and to feel stigmatized by their breast cancer treatment.

"It's important for women to think about all of those issues at the time that they're making their surgical decision and realize that although breast conserving surgery may or may not be less disfiguring than mastectomy, they're likely to experience some asymmetry afterwards that may impact their quality of life," says Jennifer Waljee, M.D., M.P.H., the study's lead author.

Researchers say the study may indicate that while surgeons counsel mastectomy patients on the type of aesthetic changes to be expected, breast-conserving-surgery patients may not be as well-advised. They add that reconstructive surgery can be an option for patients who undergo either surgery.

"It's important for breast surgeons to have an open and honest dialog with their patients so that they understand patients' expectations before surgery and can better address post-operative recovery needs," Waljee says.