How Decision-Making Habits Impact Breast Cancer Treatments


A recent study discovered that more than 50% of women with early stage breast cancer categorized as an aggressive type of surgery to remove both breasts. The way women normally handle big decisions, tied together with their values, impacts what breast cancer treatments they consider, according to the study.

Contralateral Prophylactic Mastectomy is a procedure to remove both breasts when cancer pops up in only one breast, has become more popular in recent years, with more than 20% of patients choosing it. For the majority of women, removing the unaffected breast does not improve the survival rate.

To grasp what factors are steering these increases, researchers at the University of Michigan asked women how they handle the emotional side of the decision-making process, if they often regret their decisions or if they take a more intuitive approach and how much they want their doctor to direct them on what to do.

“The decision-making process is complicated. We found there are a lot of values that come into play,” quotes lead study author Sarah T. Hawley, Ph.D., MPH, professor of internal medicine at Michigan Medicine.

The research surveyed 2,362 women recently diagnosed with early stage breast cancer. Women were asked how passionate they considered prophylactic contralateral mastectomy as an option for treatment. They were also asked about their values and their decision-making principles.

Approximately 54 percent of women reported they considered a double mastectomy, with 25% saying they strongly considered it. Results are published in the journal Cancer.

Women who reported they were worried about making a bad decision were more likely to consider double mastectomy. Those who considered themselves more logical in their decision making considered it less often than those who said they go with their gut.
“Fears about radiation are common, so it is very important to make sure women are fully informed before they make the decision to pursue much more aggressive surgery than they need,” quotes study author Reshma Jagsi, M.D., D.Phil., professor and deputy chair of radiation oncology at Michigan Medicine.

“We need to make sure women understand how far technology has advanced to make radiation treatment safe and tolerable. We also need to make sure women understand that even after mastectomy radiation might be recommended, if the cancer has certain features,” she continues.

Also, women who reported they wanted to make their own decisions most of the time, rather than depending on their doctor, strongly considered double mastectomy. The findings indicate that this more aggressive treatment seems to be pushed by patient desire, rather than a recommendation from a physician.

“It goes against what the traditional shared decision-making model would suggest, which is when you involve people and inform them fully, most people would be inclined to choose less extensive treatment,” Hawley states.

The researchers signal that physicians and decision aids need to think about patient values during the process. Hawley and colleagues have developed a decision tool that walks patients through an exercise to prioritize their values, mapping those values to potential treatment decisions. They plan to widen that based on these findings.

“If physicians have feedback that a patient likes to make decisions a certain way, they can understand the patient’s emotional processing and help the patient make a decision that meets her needs physically and emotionally,” Hawley quotes.

This could result in educating patient about misperceptions around fears. A lot of patients overestimate the chance of the cancer coming back, and they possibly might not understand the impact of double mastectomy. It could also simply mean acknowledging a patient may feel uncomfortable with some treatment recommendations.

“A lot of these conversations around therapy — including extensive therapy that may not be truly beneficial in terms of survival — may come down to emotional values. Physicians need to help patients feel comfortable with treatment decisions within their underlying nature and values. This includes helping patients understand when less extensive treatment might be the right option. Patients need to feel secure in knowing that choice will give them their best chance at survival,” Hawley concludes.


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