Catheryn Yashar, MD
For a newly-diagnosed breast cancer patient, the sheer number of treatment decisions can be overwhelming. In order to make the most appropriate choices for her life, a woman must know what her options are and feel empowered to make those decisions. But are women fully aware of the options available to them?
According to a national survey by The BC5 Project, a group focused on broadening awareness of breast cancer treatment options, the answer is no. Based on responses from 100 women age 50+ who have been diagnosed with breast cancer, one-third were only presented with one treatment option from their physicians, and only 27 percent sought a second opinion on their diagnosis or treatment. Radiation oncologist Catheryn Yashar, MD, of University of California, San Diego, discusses the survey, what the results mean for women and how physicians can work to close this knowledge gap.
In your opinion, how often are women making treatment decisions without knowing all their options?
As the survey suggests, I think it happens far too often. For instance, when asked specifically about breast brachytherapy, less than one in 10 women even know the option existed, while 75 percent of those who would have been candidates for the treatment said they would have been interested in the therapy.
When women don’t have enough knowledge about their treatment options, it can lead to making choices that aren’t appropriate for their situation. Women don’t know that they need to make choices about what’s right for them physically, psychologically and in the context of their lifestyle. And too often, I encounter a newly-diagnosed, frightened woman who doesn’t know that the choice for treatment is hers to make. The surgeon, medical oncologist, and the radiation oncologist are all there to help guide her, but ultimately the decision has to be hers.
Do you think the option of breast conservation therapy is being offered as widely as it should be to appropriate candidates?
There’s concerning data from a recent Harvard/Dana Farber study that shows the growing number of women who are inclined to have their breasts surgically removed as an alternative to the equally effective breast conserving surgery. It certainly raises the question of whether or not women are fully aware of all the options. For most women, breast conservation is an appropriate choice. Too many women opt for mastectomy, even when the diagnoses indicate there is little chance of recurrence, because they want to be “sure” it won’t come back, or think this improves their chance of survival. Women sometimes choose to have perfectly healthy breasts removed because they’re misguided, misinformed, or too overwhelmed to weigh the options objectively.
What approach do you take when counseling patients on treatment options?
When a patient asks me what to do, I outline all her options and help her assess them in the context of her level of comfort, the data available concerning each option, and her lifestyle. There are a lot of variables with breast cancer, in terms of both the disease itself (e.g., stage, tumor type, location) and treatment. Women with early-stage breast cancer have the most options, but sorting through them can seem overwhelming.
The point is, there isn’t just one approach — or one context in which choices should be made. A woman has to choose a treatment plan that makes sense for her in every way. And she can only do that when she knows what her options are, and feels empowered to make the decision.
So what can physicians do to help close this “knowledge gap”?
First, we should strive to take on a more active role in becoming aware of all the options ourselves and making ourselves familiar with the available data so we’re better prepared to pass that knowledge on to our patients.
I also think empowering women to seek information and advice from a support network– that is, women who have faced similar health challenges – is incredibly valuable. At the UCSD Moores Cancer Center, we formed a local SAVI Sisters support group for patients who received SAVI breast brachytherapy. With SAVI Sisters, my patients can gain a better understanding of their treatment options through the stories and experiences of other women. This can happen both on a national level through the SAVI Sisters website, and at a local level by connecting my patients with each other here in Southern California. Not only can SAVI Sisters help other women, but they can also help spread the word to their primary care doctors and OB/Gyns, who may not know about SAVI or other partial breast irradiation treatments.
Dr. Yashar currently serves as the Chief of the Gynecologic Cancer and Breast Cancer Services in the UCSD Department of Radiation Medicine and Applied Sciences. She is also part of The BC5 Project, a recently formed consortium organized to broaden awareness about breast cancer treatment options. The goal of The BC5 Project is to use education and awareness to empower women diagnosed with early-stage breast cancer to drive the conversation about treatment options and take an active role in choosing their own treatment.