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Wednesday, 20 March, 2002, 12:06 GMT
No choice for cancer women
Breast scan
There are often different treatment options
Women diagnosed with breast cancer are not being given enough choice of treatment and may be having their breasts removed unnecessarily, research suggests.

Work carried out at the Ulleval University Hospital in Oslo, Norway, has revealed breast cancer surgeons do not always offer a choice between mastectomy and breast-conserving surgery followed by radiotherapy to women with early stage breast cancer.


Each woman has the right to know they have two options for their cancer

Inger Schou Bredal
The research comes after leading British expert Professor Michael Baum, of University College London, questioned the need for many mastectomies.

He claimed that hundreds of women were undergoing unnecessary surgery because doctors were carrying out the operation as a precaution when discovering tumours.

The Norwegian researchers examined how patients' perceptions of choice compared to surgeons'.

They also looked at whether women's choice of surgery was influenced by the same factors that steered surgeons towards mastectomy.

Inger Schou Bredal, a doctoral student in nursing science at the hospital, asked 194 women with early stage breast cancer and 25 surgeons to complete questionnaires.

Disparity

She found that even though surgeons considered it was medically appropriate to give 81% of women a choice between mastectomy (MAS) and breast conserving surgery (BCS), they only offered a choice in 62% of cases.

Among the patients, 59% of the women felt they had been offered a choice between the two.

In only 38% of cases was there complete agreement between the women's assessment of receiving a choice and the surgeons' of giving a choice,

Factors that most affected the women's choices were fear of cancer recurrence (in 89% of cases), the necessity of further treatment (72%) and the surgeons' recommendations (70%). For surgeons, medical assessment (in 97% of cases) was the most important factor, followed by the breast appearance in relation to surgical outcome (82%).

Women who were not given a specific recommendation tended to choose BCS (66%).

UK similar

Mrs Schou Bredal said Norway had a low rate of BCS and suggested it was a similar situation in the UK.

She said this might account for the lack of choice women had or were given in some cases.

She said: "Each woman has the right to know they have two options for their cancer.

"We know that removing or keeping the breast doesn't have any effect on prognosis in the early stages - those women with small tumours.

"However, if the tumour is more than 5cms it is a different matter.

"Not all women are getting a choice and they should do if they want to."

More information

She is urging the medical profession to give women more options and more information.

She said: "I'm appealing to the surgeons that women are not getting a choice and that women should be taking a greater role in that decision making process if they want to."

She found that women surgeons were more likely to give their patients a choice, which she said underlined the subjective nature of breast cancer treatment.

She suggests it could be argued that female patients have more empathy with their patients and therefore more female surgeons should be recruited.

The research was presented at the European Breast Cancer Conference in Barcelona.

See also:

19 Mar 02 | Health
Breast screening benefits hailed
15 Mar 02 | Health
Relief over breast drug decision
02 Mar 02 | Health
Breast care cost questioned
01 Dec 01 | Health
Women fail to spot breast cancer
05 Nov 01 | Health
Breast 'most common cancer'
17 Mar 00 | C-D
Breast Cancer
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