One more reason you really don't want to get breast cancer

We’d like to think that the health care delivery system puts patient needs first and ensures that patients and families have the right information in mind before making momentous treatment decisions. Unfortunately, despite a great deal of awareness raising and education, this still is not the case. Radiation oncologists are publicizing a new study that blames surgeons for often excluding radiation oncologists from the decision-making process for breast cancer patients considering mastectomy. The result: patients don’t have full information and may choose mastectomy when they might really be better off with breast conserving therapy.

The article notes that multidisciplinary collaboration in cancer care is becoming the norm, but even so it’s not working out as advertised.

From the patient perspective, there are a number of troubling aspects to this story. I’m no expert on breast cancer, but here are some things to keep in mind based on my read of this article:

  1. Surgeons like to cut. I hope you know that already. Even the best have a bias toward surgery, so if you consult a surgeon don’t be surprised if a surgical solution is suggested and even assumed, and that a consultation leads right into scheduling a procedure without a wider discussion of options
  2. Surgeons are very familiar with surgery, but might be a little hazier on post-surgical recovery. In the case of breast cancer, many patients –especially those that choose surgery due to fears of radiation– are surprised to find out they may need radiation after surgery anyway. If they’d known before they might have skipped the surgery
  3. When surgeons and radiation oncologists actually do consult with one another, they tend to have conflicting views. That means it’s up to the patient –who presumably is less well trained than the doctors to make a scientific/medical judgment– to reconcile the advice. I don’t find that very helpful

There’s not much an individual patient can do about the state of affairs. But as a first step, don’t just assume the expert has provided the full set of options.

April 18, 2012

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