Commentary—Surgical Decisions after Breast Cancer: Can Patients Be Too Involved in Decision Making?

Abstract

In this month's Health Services Research Lantz Janz, and Fagerlin et al. explore patient satisfaction with decisions about surgical treatments for early stage breast cancer among a population-based sample of women. Deciding whether to undergo breast conserving therapy (BCT) or mastectomy remains difficult for women diagnosed with early stage breast cancer. Despite the substantial differences in the side effects of these treatments, no survival differences have been shown up to 20 years later among women with stage I and II cancer (Veronesi et al. 1981; Fisher et al. 1985; Sarrazin et al. 1989; Blichert-Toft et al. 1992; Lichter et al. 1992; Early Breast Cancer Trialists' Collaborative Group 1995; Morris et al. 1997; van Dongen et al. 2000; Fisher et al. 2002). Although randomized trials suggested higher quality of life (QoL) and satisfaction among women receiving BCT as compared with mastectomy (Moyer 1997; Curran et al. 1998), a substantial percentage (36 percent) undergo mastectomy. Despite the psychosocial benefits associated with reconstruction after mastectomy, most women (60 percent) do not choose reconstruction (Cancer Statistics Review 1973–1989; Mueller et al. 1988; Sorrentino et al. 1988; Handel et al. 1990; Brown 1991; McKenna et al. 1991; Schain 1991; Dowden and Yetman 1992; Noguchi et al. 1993; Corral and Mustoe 1996; Street and Voigt 1997).