The 130th Annual Meeting of APHA

Abstract #45727

Alice B. Fox, DrPH, Beth Israel Medical Center, Peter Krueger Clinic, 317 E. 17th Street, New York, NY 10003, 212-420-2116, afox141@aol.com

For women with stages I and II breast cancer, clinical trials hve demonstrated equivalent survival rates between two primary treatments: modified radical mastectomy and breast conserving surgery. Women with stage 0 breast cancer, ductal carcinoma in situ (DCIS), are also faced with treatment choices, although there is no clinical consensus regarding management for this disease at this time. Twenty women with early stage breast cancer were interviewed for this study, fifteen prior to their surgery, the other five within several weeks of surgery, in an open-ended format. Three participating breast surgeons were also interviewed. The context of decision making was undertaken through the observation of surgical and diagnostic procedures and weekly breast conferences. Interviews with women revealed an unexpected lack of involvement with decision making. Eighteen women expressed no sense of choice of treatments, though only two were uncomforable with choices made. On the other hand, women talked about their new cancer diagnosis in ways which suggested important shifts in their identity and the broader meaning of cancer in their lives. Interviews with surgeons and observation of breast conferences revealed striking ambiguity in clinical factors related to surgical choices. Especially in the treatment of DCIS, surgeons felt it was up to them to guide treatment choices. This reseach suggests that surgeons have taken the lead in advising women regarding the surgical management of their breast cancer. In light of this finding, more time might be taken in the period following a breast cancer diagnosis to ensure that women are comfortable with choices made, and to allow the non-clinical concerns of women to be voiced.

Learning Objectives:

• At the conclusion of the session the participant will be able to describe, from the woman's point of view, the experience of receiving a breast cancer diagnosis and living through the diagnostic procedures leading to surgery; to discuss the personal complexities that decision-making for this disease entails and to evaluate existing programs for both time spent and quality of time pre-surgery.

Keywords: Breast Cancer, Breast Cancer Programs

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Beth Israel Medical Center, New York, New York
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.