Dr. Dixon Discusses Making Mastectomy Decisions

J. Michael Dixon, MBChB, MD, Professor of Surgery, Consultant Surgeon, University of Edinburgh, Clinical Director of the Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, discusses the challenges facing patient choice in the mastectomy decision process.

Dixon explains that the common perception is that patient choice leads to better results, however, there is a lack of supporting evidence in the literature for this theory. In an examination of the decision making process it was found that when surgeons alone chose the treatment it resulted in approximately 5% of patients receiving mastectomy. In joint decisions, 15%-18% of patients received mastectomy and when patients chose nearly 30%-40% received mastectomy.

Women who face the choice of breast-conserving surgery over mastectomy are making the decision based on fear of cancer recurrence and death. However, Dixon notes, a significant different is not observed in a comparison between mastectomy and breast-conserving surgery.

The fear of recurrence appears to be primarily a US related issue. In a comparison, the number of women in the US having mastectomy is increasing while mastectomies in Europe are decreasing.