The type of surgery a breast cancer patient receives depends la Type of Breast Cancer Surgery a Woman Receives Depends on Surgeon’s Choice (dateline December 6, 2000) | Breast Health News | Imaginis - The Women's Health & Wellness Resource Network

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Type of Breast Cancer Surgery a Woman Receives Depends on Surgeon’s Choice (dateline December 6, 2000)

The type of surgery a breast cancer patient receives depends largely on the choice of her surgeon, according to a study presented at the annual meeting of the Radiological Society of North America (RSNA) in Chicago this past November. Previous studies have suggested that geographical location may influence the type of treatment patients receive. However, this latest study finds that surgeon-patient interaction is most important in determining whether a woman will undergo breast-conserving surgery (lumpectomy) or mastectomy (removal of the entire breast).

To conduct the study, Lillian Rinker, MD, a radiation oncologist at Methodist Healthcare-Central Hospital in Memphis, and her colleagues analyzed the medical records of 142 women with small breast cancers (4 centimeters or less in diameter). According to Dr. Rinker, all of the women were eligible for lumpectomy, followed by radiation therapy. However, only 47% of the women had breast-conserving surgery; the others underwent mastectomy.

The researchers found that the surgeon’s choice strongly influenced whether a woman had a lumpectomy or mastectomy. In the study, 33 surgeons performed procedures, but five surgeons were responsible for treating 60% of the women. Among those five surgeons, the number of lumpectomies that were performed varied considerably from surgeon to surgeon (from 81% to only 9%).

According to Dr. Rinker, many women are afraid that lumpectomy is not as effective as mastectomy, and when they communicate that fear to their surgeon, they get the impression from the surgeon that mastectomy is a safer option, which may not be the case.

While the likelihood that breast cancer will recur is higher with breast-conserving surgery than with mastectomy, studies have shown that both surgeries are effective for women with early-stage breast cancer. In a 10-year study presented last December at the San Antonio Breast Cancer Symposium, researchers found no difference in the long-term survival among women with ductal carcinoma in situ (an early stage breast cancer), regardless of whether the women had lumpectomy or mastectomy.

In the study presented at the RSNA, Dr. Rinker and her colleagues found that surgeons who regularly communicate with other physicians about treatment issues are more likely to perform breast-conserving surgery than surgeons who do not attend interdepartmental conferences. Many hospitals and organizations make efforts to bring physicians together to discuss treatment approaches. For example, the Methodist Healthcare Multidisciplinary Breast Cancer Conference began in October 1998 as a means for different physicians involved in breast cancer treatment to discuss a variety of issues. Also, the Memorial Sloan-Kettering Cancer Institute organizes "tumor boards" where physicians can come together to discuss methods of treating cancer.

According to Dr. Rinker and her colleagues, women need to be informed of all of their treatment options and discuss them with their surgeons. Patients are encouraged to ask surgeons how many lumpectomies they perform on early-stage breast cancer patients compared to mastectomies. Patients should also feel free to seek a second opinion from another surgeon before undergoing any procedure.

Ultimately, women eligible for either procedure should carefully weigh the advantages and disadvantages of lumpectomy and mastectomy. Lumpectomy may preserve the physical appearance of the breast but usually requires several weeks of radiation therapy. Mastectomy may reduce the chances that of breast cancer recurrence, but additional decisions about breast reconstruction are introduced. A recent study found that women who have breast-conserving surgery are more satisfied with their body image after breast cancer than women who undergo mastectomy followed by breast reconstruction. It is estimated that 45% to 60% of eligible patients receive lumpectomy in the United States.

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