Friday, March 26, 2010

Health decision making: New cancer treatment findings

Several interesting studies being presented at the European Breast Cancer conference in Spain are highlighting the difficulties that many women face when trying to decide on the appropriate course of treatment, prevention, or screening.

The decision can be especially challenging for women who have tested positive for mutations in the “breast cancer genes,” known as BRCA1 and BRCA2. Such women face a 55% to 85% chance of developing the cancer sometime in their life. These genetic mutations are inherited, and many women with a long list of female relatives who have suffered from the cancer choose radical preventive approaches, such as prophylactic mastectomy, or removal of one or both healthy breasts, either before a first incident of cancer, or to prevent a recurrence. This is based on the assumption that removing healthy tissue will reduce the risk of new or recurrent cancer.

Two new studies looked at prophylactic mastectomy of the healthy breast in women recovering from the cancer, who had BRCA1/2 mutations. After following 138 women who opted for risk reducing mastectomies, and comparing them to 210 similar women who opted for routine surveillance without the operation, researchers found no difference in overall survival. In other words, women who opted for risk-reduction surgery did not live longer or die of cancer less frequently than those who did not have surgery.

The second study looked at the chances of cancer recurrence in women who opted for total mastectomies compared to less radical “breast conserving treatment,” or BCT. After 15 years, 23.5% of women who chose BCT had a second bout of cancer, compared with only 5.5% of women who opted for total mastectomy. However,
women receiving adjuvant chemotherapy along with BCT had no greater risk than the mastectomy group. The researchers concluded that BCT with chemotherapy is a sensible option for women who do not want to undergo total mastectomy.

A third study being presented underlines the importance of clear risk communication to those suffering from or at risk of developing cancer. In a small study of 27 women being treated for cancer in one breast, a British surgeon reports that women who chose prophylactic mastectomy of their healthy breast did so, at least in part, because they overestimated the risk of developing future cancer by up to ten times. A small study for sure, and with not entirely unexpected results, but an important reminder that risk communication is both difficult, and important in helping patients decide which course of treatment is best.

Photo credit
: The author

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