title: Patient involvement in surgery treatment decisions for breast cancer.
abstract: OBJECTIVE
  High rates of mastectomy and marked regional variations have motivated lingering concerns about overtreatment and failure to involve women in treatment decisions. We examined the relationship between patient involvement in decision making and type of surgical treatment for women with breast cancer.
  
  
  METHODS
  All women with ductal carcinoma-in-situ and a 20% random sample of women with invasive breast cancer aged 79 years and younger who were diagnosed in 2002 and reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results registries were identified and surveyed shortly after receipt of surgical treatment (response rate, 77.4%; n = 1,844).
  
  
  RESULTS
  Mean age was 60.1 years; 70.2% of the women were white, 18.0% were African American, and 11.8% were from other ethnic groups. Overall, 30.2% of women received mastectomy as initial treatment. Most women reported that they made the surgical decision (41.0%) or that the decision was shared (37.1%); 21.9% of patients reported that their surgeon made the decision with or without their input. Among white women, only 5.3% of patients whose surgeon made the decision received mastectomy compared with 16.8% of women who shared the decision and 27.0% of women who made the decision (P < .001, adjusted for clinical factors, predisposing factors, and number of surgeons visited). However, this association was not observed for African American women (Wald test 10.0, P = .041).
  
  
  CONCLUSIONS
  Most women reported that they made or shared the decision about surgical treatment. More patient involvement in decision making was associated with greater use of mastectomy. Racial differences in the association of involvement with receipt of treatment suggest that the decision-making process varies by racial groups.
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of Michigan, 300 N Ingalls, Ste 7E12, Box 0429, Ann Arbor, MI 48109-0429, USA. skatz@umich.edu
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Katz
authors.forename: Paula M
authors.initials: PM
authors.lastname: Lantz
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Janz
authors.forename: Angela
authors.initials: A
authors.lastname: Fagerlin
authors.forename: Kendra
authors.initials: K
authors.lastname: Schwartz
authors.forename: Lihua
authors.initials: L
authors.lastname: Liu
authors.forename: Dennis
authors.initials: D
authors.lastname: Deapen
authors.forename: Barbara
authors.initials: B
authors.lastname: Salem
authors.forename: Indu
authors.initials: I
authors.lastname: Lakhani
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000601:surgery*; D003657:Decision Making; D005260:Female; D006801:Humans; D016015:Logistic Models; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D018426:SEER Program