BREAST CANCER: Are Patients Getting Unnecessary Care?

      "Tens of thousands of American women with breast cancer are losing a breast unnecessarily each year because their doctors do not follow national guidelines in treating the breast cancer," according to the "first comprehensive study of current" breast cancer practices. The New York Times reports that 180,000 women are diagnosed annually with breast cancer, and nearly two-thirds, or 117,000 of these cases are classified as "early stage." Of these early stage cases, 75% are eligible for lumpectomy surgery and radiation treatment, a procedure referred to as "breast conserving." But a study presented Monday at an American Society of Clinical Oncology meeting found that of 18,000 early stage cases in 1994, only 44% of the women chose the breast conserving procedure. According to lead study author Dr. Monica Morrow of Northwestern University's Medical School, about 20% of lumpectomy-eligible women "choose to have mastectomies instead" (Altman, 5/19)

Influencing Factors
      Morrow said her study found geographic variations in mastectomy rates. While 39% of breast cancer patients in the Midwest "received lumpectomies," the rate was 56% "in the Northeast and 48% on the West Coast." The South had the lowest lumpectomy rate, 33%. The study further "found that women who had private insurance or were HMO members had a higher rate of lumpectomies (49%) than women who were uninsured or on Medicaid (41%) and women on Medicare (39%)" (Lerner, Minneapolis Star Tribune, 5/20).

Why Ask Why?
      Morrow said the study illustrates that "if you are told you need a mastectomy, ask why." She said most breast cancer specialists "believe that if you have bad breast cancer, you are better off being treated with a mastectomy. That is simply not true." The New York Times reports that a "number of studies published over the last 15 years have shown that survival after mastectomy and breast conserving surgery were equal." The new study also found that the older a woman was when diagnosed with breast cancer, the more likely she was to undergo mastectomy than lumpectomy. Morrow said "it is more a perception that older women may not value keeping their breast and therefore it is not worthwhile talking to them about it" (5/19).