A report published in the Los Angeles Times says surgeons who care for women with early-stage breast cancer “face a growing dilemma.” Really, the surgeons are under duress of some kind? [LA Times, Dec 21, 2016]
The problem is, as the LA Times article reads: “17% of women with early breast cancer have unnecessary mastectomies AND DOCTORS DON’T KNOW WHY.”
Doctors do know why — fear.
The 17% figure emanates from a report published in the Journal of the American Medical Association Surgery [Dec 21, 2016]
That journal report says about a third of patients (39%) with diagnosed breast cancer and no high-genetic risk or mutation received a recommendation from their surgeon NOT to undergo breast removal (mastectomy) in the opposing healthy breast, which results in only a few women (1.9%) undergoing the operation. But among women whose surgeons made no recommendation against mastectomy in the healthy non-cancerous breast, more (19.0%) opted for prevention via surgical removal. Therefore, this represents 17% overtreatment.
A mindless female reporter acts as if the surgeons are undergoing an ordeal of some kind. It is the fearful patients who are being left to their own poor judgment. Surgeons are reported to say: “Ironically, a physician’s desire to support patient autonomy may result in excessive surgery if patients are misinformed (actually uninformed), as our results suggest is common.”
The American Society of Breast Surgeons advises doctors to steer most women away from surgical breast removal of a healthy breast. [Annals Surgical Oncology 2016]
As to why these women chose to undergo needless surgery, 43.5% said they knew that removal of a healthy breast does “not prevent cancer from recurring for all women with breast cancer,” and 17% thought that it did (this represents frank lack of education and informed consent from surgeons) and 39.5% played dumb and said they didn’t know.
Here is the big reason why women proceeded to the surgical suite – 96% said they opted for removal of a healthy breast because of the need for “peace of mind.” This is not a decision being made upon facts but rather emotion.
Who is going to put a halt to all this? Greedy tight-lipped surgeons on one hand (nobody will call it that) and fearful women on the other. Block these women from opting for needless surgery and there is going to be predictable outrage and opposition, calling this rationing of care or invasion of the doctor/patient relationship.
And you wonder why health care costs are so high?