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Patient Involvement in Surgery Treatment Decisions for Breast Cancer

From the Division of General Medicine, Department of Internal Medicine, Department of Health Management and Policy, Department of Health Behavior and Health Education, University of Michigan; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor; and Wayne State University School of Medicine, Department of Family Medicine, Karmanos Cancer Institute, Population Studies Program, Detroit, MI; Department of Preventive Medicine, University of Southern California, Los Angeles, CA; and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA

Address reprint requests to Steven J. Katz, MD, MPH, Departments of Medicine and Health Management and Policy, University of Michigan, 300 N Ingalls, Ste 7E12, Box 0429, Ann Arbor, MI 48109-0429; e-mail: skatz{at}umich.edu

PURPOSE: High rates of mastectomy and marked regional variations have motivated lingering concerns about overtreatment and failure to involve women in treatment decisions. We examined the relationship between patient involvement in decision making and type of surgical treatment for women with breast cancer.

METHODS: All women with ductal carcinoma-in-situ and a 20% random sample of women with invasive breast cancer aged 79 years and younger who were diagnosed in 2002 and reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results registries were identified and surveyed shortly after receipt of surgical treatment (response rate, 77.4%; n = 1,844).

RESULTS: Mean age was 60.1 years; 70.2% of the women were white, 18.0% were African American, and 11.8% were from other ethnic groups. Overall, 30.2% of women received mastectomy as initial treatment. Most women reported that they made the surgical decision (41.0%) or that the decision was shared (37.1%); 21.9% of patients reported that their surgeon made the decision with or without their input. Among white women, only 5.3% of patients whose surgeon made the decision received mastectomy compared with 16.8% of women who shared the decision and 27.0% of women who made the decision (P < .001, adjusted for clinical factors, predisposing factors, and number of surgeons visited). However, this association was not observed for African American women (Wald test 10.0, P = .041).

CONCLUSION: Most women reported that they made or shared the decision about surgical treatment. More patient involvement in decision making was associated with greater use of mastectomy. Racial differences in the association of involvement with receipt of treatment suggest that the decision-making process varies by racial groups.

Supported by grant No. RO1 CA8837-A1 from the National Cancer Institute to the University of Michigan and by federal funds from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services, under Contract Nos. N01-PC-35139 and N01-PC-65064. The collection of cancer incidence data used in this publication was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885.

The ideas and opinions expressed herein are those of the author, and no endorsement by the State of California Department of Health Services is intended or should be inferred.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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