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Second Opinion Impacts
Women's Decisions About Breast Cancer Treatment, Says New Study -
Study Also Finds Women Not Always Given All Options to Consider
Getting a second opinion
changes the course of treatment for many women diagnosed with breast
cancer, says a recently published report. The study, published in February
in the journal Cancer, also indicates that many women are not
given options other than mastectomy to consider in their treatment of
the disease.
Researchers at Northwestern University
who set out to determine how often a second opinion changes the way
a woman chooses to have her breast cancer treated, found that only 46
percent of patients had complete treatment options presented to them
prior to obtaining a second opinion. They also found that second opinion
changed the course of treatment in 20 percent of patients after seeking
a second opinion.
Their study underscores the need for second
opinion programs for breast cancer treatment, say the researchers, as
these programs result in changes in therapy for a significant number
of patients and increase the likelihood that patients will be fully
informed of their options.
About
the Study: Looking at Second Opinion in Breast Cancer Patients
Researchers working at the Lynn Sage Breast
Center at Northwestern University looked at 231 women with ductal carcinoma
in situ or Stage I and II invasive breast carcinoma - cancers confined
to the breast tissue that may have only minimal lymph involvement -
who were diagnosed at outside institutions but sought second opinions
at the center.
Prior to consulting a physician at the
center, patients were administered a questionnaire to determine their
reason for seeking a second opinion, what treatment options had been
previously discussed with them, and the patient's choice of therapy
if that decision had also been made. Demographic information was also
collected.
The women in the study ranged from 25
to 82 years of age, with the average age being 51 years. Eighty-nine
percent of the women were Caucasian. In addition, 70 percent of the
women had more than a high school education and 80 percent were employed
outside the home.
The researchers found that the second
opinion regarding appropriate treatment offered at the center differed
significantly from the initial surgical opinion in one out of five patients
(54 patients). In addition, fewer than half the women said they had
all their surgical options presented to them at the time of the original
consultation. Many who were eligible for breast conserving procedures
were offered only mastectomy.
Options for women with cancer in these
stages include mastectomy alone, mastectomy with immediate breast reconstruction,
and breast-conserving surgery. In breast-conserving surgery, surgeons
remove the tumor itself while taking as little of the surrounding tissue
as possible.
In the study, 23 women who had contraindications
to breast-conserving surgery as described by the American College
of Surgeons, the American College of Radiology, and the College
of American Pathologists, had this option presented to them. In
addition, it was found that 31 women with no contraindications to breast-conserving
surgery had only been offered mastectomy as a treatment option.
Women with contraindications to breast-conserving
surgery include those with multiple tumors in separate areas of the
breast and prior radiation therapy treatment to the affected breast
region.
Breast-Conserving
Therapies are Poorly Understood, Say Study Authors
According to the study's authors, there
is considerable evidence to suggest that the selection criteria for
breast-conserving surgery are poorly understood. These guidelines were
developed by a joint committee of the American College of Surgeons,
the American College of Radiology, and the College of American
Pathologists in 1992.
Using these guidelines, previous single
institution studies have indicated that more than 75 percent of patients
with Stage I and II breast cancers are candidates for breast-conserving
treatments, yet a national study of 16,643 patients treated in 1994
found that only 43 percent underwent breast-conserving therapies.
The authors believe their study demonstrates
that a second-opinion program for the surgical treatment of breast cancer
patients results in a change in treatment recommendations for a substantial
number of women, in addition to serving the purpose of informing women
of all the treatment options available to them.
They cite numerous studies that support
the importance of the surgeon educating women about all the treatment
options available to them.
Always consult your physician for more
information.
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