Breast Cancer: Women Often Choose Mastectomy

Surgeon, Family Opinions Affect Patients' Decisions

By Salynn Boyles
WebMD Health News

Reviewed By Louise Chang, MD

Sept. 1, 2009 -- Thirty-eight-year-old mother of three Ellyn Davidson says she knew within seconds of hearing her breast cancer diagnosis two years ago that she wanted her breasts removed, even though she could have opted for breast-conserving surgery.

"My doctor called to tell me I had cancer at 9:30 on a Thursday night and after the initial shock, I said, "I'm going to get rid of my breasts, then,'" she tells WebMD. "He started to tell me about other things we could do, but I think he could tell my mind was pretty much made up."

Davidson knew the cure rate was about the same with the two surgeries for her early-stage cancer, but she wanted to be as aggressive as possible in treating her disease.

A new survey of women with breast cancer shows that Davidson's reaction was not atypical.

Many Women Chose Mastectomy

Women with early-stage breast cancer who said they were most involved in the decision-making process were also the most likely to have a mastectomy.

Women who said they relied on the opinion of their surgeon or a family member or friend to decide which surgery to have were more likely to choose breast-conserving surgery with lumpectomy.

This was true for all racial and ethnic groups surveyed, including African-American women and Latina women, says lead researcher Sarah T. Hawley, PhD, MPH, of the University of Michigan Health System.

"There appears to be a subset of women who prefer mastectomy," Hawley says. "This choice is based on their attitudes about the two surgeries. We just want to make sure those attitudes are based on accurate knowledge."

A total of 1,651 women with early-stage breast cancer who were candidates for mastectomy or breast-conserving surgery answered the survey. The women lived in Los Angeles or Detroit and 49% were white, 27% were African-American, and 24% were Latina.

About three-fourths of the surveyed women ended up having breast-conserving surgery, Hawley says.

The responses also revealed that:

  • Women who expressed the most concern about their cancer returning or the effects of radiation with breast-conserving surgery were more likely to choose mastectomy than women who expressed less concern about these things.
  • Women who reported that body image and their spouse's opinion were important in their decision-making process were more likely to choose breast-conserving surgery.
  • Most women reported having a family member or friend accompany them during their surgical consultations.

The findings appear in this week's issue of the Journal of the National Cancer Institute.

Support Is Critical During Decision-Making Process

Amy Rauch Neilson, 39, says she relied on family and friends after receiving her breast cancer diagnosis in March 2006. Her husband, Don, and sister, Lisa, accompanied Neilson every time she met with doctors to discuss her treatment.

"They just kept coming, and their support meant everything," she says. "Even if you think you're strong enough to do it yourself, you really need support."

Like Davidson, Neilson opted for a double mastectomy almost immediately because of her young age, a family history of the disease, and a strong suspicion that she had the BRCA1 gene that by some estimates carries up to an 80% lifetime risk for developing breast cancer.

Neilson's maternal grandmother died of breast cancer when she was 46 and her mother died of the disease at age 53. In 1985, her older sister, Julie, was treated for cancer in one breast at age 26. Two years later, she was treated again when cancer was found in the other breast.

Neilson's suspicions were confirmed soon after her double mastectomy was performed. Davidson also found out after her surgery that she carried the BRCA mutation.

Both women say they have no regrets about choosing mastectomy over breast conservation.

"The awesome thing -- if you can call anything about having breast cancer awesome -- is that breast reconstruction is just amazing these days," Neilson says. "Right after the surgeon took my breasts, the plastic surgeon came in and began the reconstruction process. So when I woke up after surgery and looked down I already had some cleavage."

Davidson says her reconstructed breasts are actually an improvement over the ones nature gave her.

"I was pretty small chested and now I have the perkiest breasts on the block," she says.

SOURCES: Hawley, S.T., Journal of the National Cancer Institute, Oct. 7, 2009; vol 101: online edition. News release, University of Michigan. News release, Journal of the National Cancer Institute. Hawley, Sarah T., PhD, MPH, research associate professor of internal medicine, University of Michigan Medical School, Ann Arbor. Amy Rauch Neilson, breast cancer survivor, Belleville, Mich. Ellyn Davidson, breast cancer survivor, Huntington Woods, Mich. American Cancer Society web site: "Detailed Guide: Breast Cancer."

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