Women with breast cancer often feel rushed to make a decision about surgery, and some of them might benefit from more time and better educational materials to inform their treatment choices, two recent studies suggest.
One study surveyed 487 women after they underwent either a lumpectomy that removes malignant tissue while sparing the rest of the breast, a mastectomy that removes the entire breast, or both procedures. Regardless of what path they took, at least one in five women said choosing quickly was more important than making an informed decision, and at least as many patients felt like they didn’t have all the facts before their operations.
“A breast cancer diagnosis can feel like an emergency when you are the patient,” said lead study author Dr. Sunny Mitchell, a breast surgeon in Stratford, Connecticut. “There is actually plenty of time to review all treatment options since survival rates are very high for early-stage breast cancer and do not change if a woman starts treatment within a few weeks,” Mitchell said by email.
Most early-stage breast cancer patients have either a lumpectomy or a mastectomy, and many of them get chemotherapy or radiation afterward to destroy any remaining abnormal cells and reduce the risk of cancer coming back. In the survey, only 47 percent of lumpectomy patients, 67 percent of mastectomy patients, and 28 percent of women who had both procedures said they felt completely informed before they had these surgeries, Mitchell and colleagues found.
A quick decision was more important than an informed decision for 35 percent of the lumpectomy patients, 31 percent of the mastectomy patients, and 22 percent of the women who had both procedures. A separate study in the same journal offers one way to help women understand their options.
For that study, researchers randomly assigned 227 women newly diagnosed with breast cancer to use an online decision-making tool or to read materials available on websites run by groups like the American Cancer Society and the National Cancer Institute. All of the women participated in the study before their first surgical consultation.
With the decision aid, half of the women scored at least 80 out of 100 on tests of their knowledge about breast cancer and treatment options, compared with a median score of 66 for women who reviewed material on various websites. At the same time, 72 percent of the women who used the decision aid recognized that they could wait a few weeks to make an informed treatment choice without affecting their survival odds, compared with just 54 percent for the other women.
“Women benefit from receiving high-quality information about breast cancer prior to their first visit with a surgeon,” senior study author Dr. Heather Neuman, a researcher at the University of Wisconsin School of Medicine and Public Health in Madison, said by email. Decision aids can help women clarify their personal values and preferences, for example by focusing on whether they want to avoid radiation or concentrate on preserving their breasts, said Dr. Clara Lee, a cancer researcher at The Ohio State University Wexner Medical Center in Columbus.
This process can also prepare women to talk to their provider about treatment options and make an informed decision, Lee, who wasn’t involved in the study, said by email. Women can still make an educated choice, aided by information online, even when they don’t use a decision aid, Lee added. “Women should look for information that presents multiple treatment options and the pros and cons of those options – not just the pros,” Lee advised. “Making a decision is about more than just information; it’s also about being clear on what is important to you and being prepared to discuss these things actively with your provider.”
