Shared decision-making and surgical treatment for breast cancer

Abstract

556 Background: Persistent high rates of mastectomy (mast) use for breast cancer have motivated lingering concerns about over-treatment. Policy makers have suggested that large regional variation in patterns of treatment is evidence of failure to involve women about the treatment they prefer. To address these issues, we examined the relationship between patient involvement in decision-making and receipt of surgical treatment for women with breast cancer. Methods: All women with DCIS and a 20% random sample of women with invasive breast cancer aged 79 and younger diagnosed in 2002 and reported to the Detroit and Los Angeles metropolitan SEER registries were identified and surveyed shortly after receipt of surgical treatment. Response rate was 74.3% (N=1489). Results: The mean age was 59.9 years; 68.7% were Caucasian, 17.0% were African American and 14.3% were of other ethnic groups. Overall, 26.4% of women received mast as initial treatment (23.6% of Caucasians, 30.2% of African Americans and 34.6% of other ethnic groups). One fifth of patients reported that their surgeon made the decision; 37.9% that the decision was shared; and 41.0% said they made the decision. The table below shows percent of patients (stages 0–2) who received mast by perceived levels of involvement and race, controlling for stage, tumor size, histologic grade, contra-indication to lumpectomy, age, and education. Patient involvement was positively associated with receipt of mast as initial surgical treatment. However, this was observed largely for Caucasian women (p=.01). Conclusions: Most women reported that they made or shared the decision about surgical treatment. Results suggest that patient preferences may partly explain persistently high rates of mastectomy and regional variation in surgical treatment. Racial differences in the association of involvement with receipt of treatment suggest that the decision-making process varies by racial groups. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration NCI RO1 CA8837-A1