Is breast cancer overtreated?

Date Visible:

08/03/2013 - 2:45pm

U-M researcher addresses concerns about how women are making breast cancer treatment choices

ANN ARBOR, Mich. - More breast cancers are being caught in an early, curable stage. About half of the 280,000 people diagnosed with breast cancer this year will have a particularly favorable prognosis.

Read the paper: "Contralateral Prophylactic Mastectomy for Breast Cancer"

But despite their good prognosis, many of these patients will receive aggressive treatments that could have little to no effect on their survival. Overtreatment can include chemotherapy (and all its incumbent side effects) or more extensive surgery (and its additional risks and more difficult recovery).

Two breast cancer researchers outline the concerns about overtreatment in two separate commentaries, both published this week.

"Patients generally feel well when they are diagnosed but suddenly they confront a major health threat and a complicated set of decisions about arduous treatments. Often, they feel compelled to make decisions before they fully understand the risks and benefits of those treatments," says Steven Katz, M.D., M.P.H., co-director of socio-behavioral research at the University of Michigan Rogel Cancer Center and the corresponding author on both commentaries.

One commentary, published in the Journal of the American Medical Association, addresses contralateral prophylactic mastectomy -- having a cancer-free breast removed along with the breast that has a tumor. For a small number of women with BRCA gene mutations or other risk factors, this surgery may be appropriate. But for most women, the likelihood of a new cancer in the second breast is much lower than the risk of the cancer spreading to other parts of the body. The operation, meanwhile, is much larger, with a longer recovery time and potentially more long-term ramifications.

"In some cases, powerful gut responses are likely driving patient preferences for the most aggressive treatment strategies. But these responses focus on the overall threat of cancer, not on the benefits and harms of each treatment option," Katz says.

He and co-author Monica Morrow, M.D., chief of the breast surgical service at Memorial Sloan-Kettering Cancer Center, stress the importance of separating clinical benefit from these "gut reactions" that may powerfully influence patients' decisions.

Katz leads a team of researchers who received a $13.5 million grant last year to look at how women make breast cancer treatment decisions.

Disclosure: None.

References: Journal of the American Medical Association, Contralateral Prophylactic Mastectomy for Breast Cancer: Addressing Peace of Mind, Aug. 1, 2013
Cancer, Addressing Overtreatment in Breast Cancer: The Doctors' Dilemma, Aug. 2, 2013.