Researchers report that mastectomy rates are remaining high despite the availability of less invasive breast cancer treatments because patients themselves are choosing more aggressive surgery.

Suspecting that high mastectomy rates may be due to surgeons not providing their patients with the option of less invasive and less disfiguring treatment, investigators from the University of Michigan Comprehensive Cancer Center and Wayne State University in Detroit carried out a survey of 1726 women an average of 6 months after undergoing breast cancer surgery.

Dr Steven Katz and colleagues found that, contrary to their concerns, women with breast cancer who said they had made their own treatment decision were more likely to have had a mastectomy than women who said their surgeon had made the decision.

This occurred despite there being other treatment options such as breast conserving surgery, which involves removing only the tumour and a small margin of tissue around it.

The primary basis for the women’s treatment decisions was concern about their cancer coming back. Indeed, women who were most influenced by the fear of recurrence of the effects of radiation therapy were most likely to have received a mastectomy.

“Our research found that it’s the patients who seem to prefer mastectomy to breast conserving therapy. Increasing patients’ involvement in treatment decisions may actually drive mastectomy rates even higher,” says Dr Katz at the annual meeting of the American Society of Clinical Oncology in New Orleans, Louisiana.

The researchers also noted that only 30% of women choosing mastectomy opted for reconstructive surgery, which creates a new breast. Indeed, women who received reconstruction reported having a lower quality of life, particularly with regard to body image, than women who underwent mastectomy or breast conserving surgery.

Generally women were happy with their treatment decision, with only 11% saying they wished they had made a different choice.