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Family, Friends May Impact Breast Cancer Surgery Decision, U-M Study FindsAbout three-quarters of women newly diagnosed with breast cancer bring family or friends to their fi rst visits with a surgeon. According to a new University of Michigan Comprehensive Cancer Center study, the person a woman brings to that appointment plays a significant role in the patient's decision making.
The study looked at factors affecting a woman's choice between a mastectomy to remove the entire breast or breast-conserving surgery, which involves removing only the tumor and is followed by radiation treatments. It found that when the patient, rather than the doctor, drives the surgery decision, the patient is more likely to choose a mastectomy. This proved to be the case among all racial and ethnic groups.
The study, which appears in the Journal of the National Cancer Institute, also found that women who had a friend or family member accompany them to the surgical consultation were more likely to receive a mastectomy. Latinas who speak little English were most infl uenced by family in their decision-making: 75%, compared to 34% of white women.
Researchers also found that factors such as concern about cancer recurrence, body image and the effects of radiation impacted a woman's surgery decision. Women who were very concerned about recurrence or radiation were more likely to choose mastectomy, while women very concerned about body image were more likely to have breast conserving surgery.
"We want to ensure a woman's decision is high quality, which means it's based on accurate knowledge about treatment risks and benefits and is consistent with the underlying values of the patient," says lead study author Sarah Hawley, Ph.D., M.P.H., research associate professor of internal medicine.
The researchers plan to develop a decision tool to help women and their families understand surgical decisions.
Study Implicates Biological Factors in Racial Disparities in Cancer Survival An analysis of almost 20,000 patient records from the Southwest Oncology Group's clinical trials database finds, for the first time, that African-American breast, ovarian and prostate cancer patients tend to die earlier than patients of other races -- even when they get identical medical treatment and other socioeconomic factors are controlled for. The finding points to biological or genetic factors as the potential source of the survival gap.
The study, published in the Journal of the National Cancer Institute, found no statistically significant difference in survival based on race for a number of other cancers, including lung, colon, lymphoma, leukemia and multiple myeloma.
"The good news is that for most common cancers, if you get good treatment, your survival is the same regardless of race," says the paper's lead author, Kathy Albain, M.D., of Loyola University. "But this is not the case for breast, ovarian and prostate cancers."
African-American patients with one of these three cancers faced a significantly higher risk of death than other patients did, ranging from a 21% higher risk for those with prostate cancer to a 61% higher risk for ovarian cancer patients.
The urgency of addressing the reasons for racial disparities in outcomes is amplified by a recent study in the Journal of Clinical Oncology. It predicts cancer incidence among minorities will nearly double by 2030, compared with an expected 31% increase among whites.
"The elimination of socioeconomic and health-care access disparities must be a priority in the United States," says Lisa Newman, M.D., director of the U-M Breast Care Center. Newman was not involved in the research. "However, Dr. Albain's landmark study demonstrates that further investigation of race- or ethnicity-associated differences in primary tumor biology is also important."
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