Can women with early-stage breast cancer make an informed decision for mastectomy?

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
E Dale CollinsKaren Sepucha

Abstract

The purpose of this study was to measure the degree to which informed women chose mastectomy, and to reveal their reasons for this choice. This was a prospective cohort study of patients radiographically and pathologically eligible for either mastectomy or breast-conserving surgery (BCS; n = 125). Participants completed questionnaires at three time points: baseline, after viewing a decision aid, and after a surgical consultation. Questionnaires assessed clinical history, preference for participation in decision making, information comprehension, values, decisional conflict, and preferred treatment. Of 125 participants, 44 (35%) chose mastectomy. Most understood that BCS and mastectomy offer an equivalent survival benefit (98%) and that BCS has a slightly higher local recurrence risk (63%); most accurately identified the magnitude of ipsilateral local recurrence risk (91%). Values assigned to three treatment attributes/outcomes ("remove breast for peace of mind," "avoid radiation," and "keep breast") clearly discriminated between patients choosing mastectomy or BCS. High decisional conflict scores improved after both the decision aid and surgical consultation. Although conventional wisdom may view BCS as the preferred treatment,...Continue Reading

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