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Conflicts in Decision-Making for Breast Cancer Surgery

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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Little is known about the interaction among surgeons, patients, and other physicians in selecting breast cancer surgery.

Methods

We contacted attending surgeons (n = 456) of a population-based sample of 2645 breast cancer patients diagnosed in Detroit and Los Angeles from December 2001 to January 2003. Eighty percent completed a written survey with clinical scenarios.

Results

The mean surgeon age was 50 years, 50% practiced in a community hospital, and breast cancer averaged 31% of practice volume. The mean number of years in practice was 17.2. Female surgeons made up 14.4% of the sample and 35% of the high-volume surgeons. Conflict with patients and other providers was reported by 58% and 32% of surgeons, respectively. When the patient preferred mastectomy and the surgeon favored BCS, conflict was reported by 49.9% of surgeons. Compared with low-volume surgeons, high-volume surgeons were significantly more likely to report conflict in this scenario (44% vs 62%; P = .047). When another provider preferred mastectomy and the respondent surgeon favored BCS, conflict was reported by 34% of surgeons and was more common for high-volume surgeons (P < .001). In a logistic regression model, surgeon volume and practice setting were strongly associated with conflict in this scenario.

Conclusion

High-volume surgeons and those in cancer centers more frequently endorse current clinical guidelines that favor BCS over mastectomy, resulting in greater conflict with patients. These findings support patient reports that patient choice is a key factor in continued mastectomy use.

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Acknowledgment

We thank the American College of Surgeons Commission on Cancer (Connie Bura and David P. Winchester, MD) for their support.

This work was funded by a grant from the National Cancer Institute (RO1 CA8837-A1) to the University of Michigan. This project has been funded in part with Federal funds from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services, under Contract No. N01-PC-35139 and NO1-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.

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Authors and Affiliations

  1. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Diane Opatt MD & Monica Morrow MD

  2. Department of Medicine, University of Michigan, Ann Arbor, MI, USA

    Sarah Hawley PhD, MPH

  3. Department of Family Medicine and Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA

    Kendra Schwartz MD, MSPH

  4. Department of Health Behavior, School of Public Health, University of Michigan, Ann Arbor, MI, USA

    Nancy K. Janz MD

  5. Departments of Medicine and Health Management and Policy, University of Michigan, Ann Arbor, MI, USA

    Steven J. Katz MD, MPH

Authors
  1. Diane Opatt MD
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  2. Monica Morrow MD
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  3. Sarah Hawley PhD, MPH
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  4. Kendra Schwartz MD, MSPH
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  5. Nancy K. Janz MD
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  6. Steven J. Katz MD, MPH
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Corresponding author

Correspondence to Monica Morrow MD.

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Opatt, D., Morrow, M., Hawley, S. et al. Conflicts in Decision-Making for Breast Cancer Surgery. Ann Surg Oncol 14, 2463–2469 (2007). https://doi.org/10.1245/s10434-007-9431-7

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  • DOI: https://doi.org/10.1245/s10434-007-9431-7

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