Breast Cancer

Making Decisions in Early-stage Breast Cancer

While more than 200,000 North American women are diagnosed with breast cancer every year, most of the time the disease is found in its early, most curable stages. This bodes well for the long-term survival of these women, but there are often many treatment decisions to make in a relative short and stressful span of time. Once the benefits of a particular treatment for a particular patient are assessed, women and their medical teams must weigh the risks and benefits in order to design the best treatment plan.

Tools for better decision-making are now in the works. A study published the July 28th issue of the Journal of the American Medical Association evaluated a decision aid, called a decision board, which includes pictures and text, that physicians can use when presenting information about surgery, which is one of the first breast cancer treatment decisions. Researchers found that the decision board helped patients make a more informed choice when deciding whether to have a mastectomy or a lumpectomy; the women were also more satisfied with their decision six and 12 months later.

Below, Clifford Hudis, MD, chief of the Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center in New York City, talks about the goals of breast cancer therapy and how treatment decisions are best approached.

What is the goal of treatment for early-stage breast cancer?
The goal of therapy for early-stage breast cancer is cure, and there are many ways to get there. Different treatment choices will often be associated with different side effect profiles, and that's where we have to have a long discussion weighing the risks and benefits of different approaches.

For early-stage breast cancer, most people will say they're willing to put up with fairly substantial side effects in the short run because their hope is that they will never hear from the cancer again. If we're going to think of a scale, it will be tipped towards more toxicity for more benefit. When we're treating advanced cancer, however, the scale may be tipped the other way. People may not want to deal with a whole lot of toxicity or give up quality of life for very marginal benefits. So these are the kinds of decisions that come into play.

What's the goal of surgery for a woman who has early-stage disease?
For early-stage disease, the goal of surgery is to remove all of the cancer with clear margins around it and to determine the risk of spread by looking at the status of the lymph nodes under the armpit.

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