Women's Health

How Does a Patient's Surgeon Influence Breast Cancer Treatment Decisions?

How Does a Patient's Surgeon Influence Breast Cancer Treatment Decisions?

When a patient is diagnosed with breast cancer one of the first treatment options is to remove the affected tissue, typically through a mastectomy. In addition to a mastectomy, a patient may also undergo chemotherapy in order to eradicate traces of the disease that may remain or have spread beyond the removed tissue. In order to prevent the spread of cancer the affected tissue has to be destroyed, and removing this tissue through a mastectomy is an effect method for quickly removing a large portion of affected cells at one time. However, as research develops both around treatment practices and around alternative methods, medical professionals are beginning to approach breast cancer treatment with a fresh perspective.

Preventive mastectomies

While some women may initially be diagnosed with bilateral breast cancer, many women may only have one affected area when they first discover the disease. Technically, once the cancerous tissue is removed through a mastectomy and chemotherapy, treatment could be finished, so long as the cancer is gone, but research shows that many patients don’t necessarily stop there. When a patient has breast cancer that only affects one breast, surgeons and patients can choose to only remove the affected breast. Some of the benefits to performing a mastectomy only on the affected breast include a more minimal procedure with a less extensive recovery as well as the preservation of one of the patient’s natural breasts.
While performing the most minimal operation possible seems ideal, many patients and treatment providers are opting for double mastectomies, even when one breast may be unaffected. Research indicates that patients may choose to undergo a double mastectomy for several reasons. First of all, the likelihood that a patient will develop cancer of the other, unaffected breast is increased if a patient has already had breast cancer. In this case, a double mastectomy can be seen as preventative treatment to hinder further spread of the disease. Additionally, some patients cite cosmetic motivations since a double mastectomy leaves a patient with a more symmetrical body which can ease some patients’ fears about appearances. While there may be valid options for undergoing a preventative mastectomy, researchers are trying to determine what factors most influence this decision.

Factors influencing treatment decisions

A study recently published in JAMA Surgery by medical researchers Steven Katz, Sarah Hawley, and Ann Hamilton attempts to understand more fully what factors influence a patient’s decision to undergo a preventative mastectomy or not. The study looked at over 3,300 women who had recently been diagnosed with early stage breast cancer and their medical care providers. The results indicate that a surgeon’s advice and perspective plays a big role in determining whether or not a patient will undergo a preventative mastectomy. The results indicated some surgeons favored conservative treatment while others did not. Among women being treated by surgeons who favored conservative treatment, the rate of preventative mastectomies was much lower. While there was a clear difference in surgery rates based on surgeon’s initial attitudes, the results also indicated that most surgeons were not opposed to preventative mastectomies when that’s what the patient wanted.

When it came to patients, the likelihood of developing breast cancer in the unaffected breast, including results from BRCA testing, was a factor influencing their decision to pursue preventative treatment. The research team used this data to suggest that the medical community should continue to educate surgeons on best treatment practices when it comes to preventative surgeries. In recent years, there has been a steady increase in the number of women undergoing unnecessary, preventative mastectomies. While there can be valid reasons for women to pursue this option, researchers indicate that conservative treatment is typically preferable so long as it is a good option. Based on the data from this research study, the biggest factor influencing the rate of preventative mastectomies is surgeon attitude which highlights the need for continued education.

Alternative treatment methods

While the debate about preventative mastectomies is far from over, there’s another discussion about the effectiveness of mastectomies that’s beginning to emerge. Traditionally, the survival rate has been basically the same between breast cancer patients who undergo a mastectomy and those who opt for a form of breast conserving surgery such as a lumpectomy instead. However, a recent research study has indicated that patients who undergo breast conserving surgery may have a better long-term survival rate.

The study that was recently published in the Journal of Global Oncology examined survival rates over a five-year period among women who had been treated for stage II breast cancer. Based on the data, women who opted for breast conserving surgery instead of a mastectomy had a survival rate that was about 18% higher. Notably, patients who opted for breast conserving surgery did also have to undergo another form of treatment such as radiation or chemotherapy in addition to the surgery that was performed. While the difference in survival rates is significant between the two groups, the data isn’t sufficient to provide a basis for any new conclusions just yet. For a long time, the data has suggested that the survival rate between the two groups is the same. Since this data contradicts popular consensus it may certainly be enough to incite further investigation into the two methods, but not enough to overturn traditional wisdom just yet.

If additional research does similarly indicate that patients who undergo breast conserving surgery have a better overall survival rate than patients who undergo a mastectomy, then women may have another reason to opt for the less invasive treatment option. Already, some patients and providers prefer using more conservative methods when possible. For patients who undergo breast conserving surgery rather than a mastectomy, they will have to experience a less invasive surgery and also have to change their physical appearance less drastically. While a patient’s physical appearance is a secondary concern to eliminating the threat of cancer, when it comes to viewing overall health it is a concern. Many patients need to seek breast reconstruction or will sometimes seek preventative mastectomies even when only one breast is affected because perceived changes in appearance affect psychological health. If breast conserving surgery does prove to predict better overall survival, then perhaps providers will encourage more women to choose this conservative treatment option.

Final thoughts

The standard treatment regimen for breast cancer patients – tissue removal surgery and chemotherapy or radiation therapy – has been the status quo for quite some time for a reason: it works. While this standard treatment method doesn’t have a 100% success rate, it does have the highest success rate possible, and so it makes sense that doctors are quick to pursue this treatment path. While there isn’t any new data at the moment that would suggest this treatment method is wrong, studies may at least suggest that doctors should consider all factors when deciding on a treatment plan with a patient. Considering a more conservative treatment approach, for example, may be better for a patient’s overall long-term health. Whether a conservative treatment plan means advising patients not to pursue preventative mastectomies or to choose a breast conserving surgery instead of a mastectomy, medical providers should be educated about all of the potential risks and benefits of both options. Being educated about standard procedures and outcomes is obviously of the utmost importance, and it should be a priority for those in charge of public health.