BUFFALO, N.Y. -- For women just diagnosed with breast cancer,
one of the important decisions confronting them is whether to have
a lumpectomy or mastectomy. A diagnosis of breast cancer will
affect one in every eight women in the United States, according to
the American Cancer Society, causing them to have to decide quickly
Most studies investigating how women make this choice have
surveyed women months and sometimes even years after their decision
was made. Recently, however, the publication of a new University at
Buffalo study, one of the few to focus on the time period between
women's breast cancer diagnosis and surgery, provides insight into
what women are thinking when faced with this decision.
In the study published in the September issue of Oncology
Nursing Forum, women who were diagnosed with early-stage breast
cancer were interviewed during the period just after surgical
consultation and before surgery. Performing the interviews at this
time allowed for an in-the-moment snapshot of how women arrived at
their decisions. These interviews were then transcribed, coded and
analyzed to identify themes in the participants' thought
"This is one of the very few studies to be conducted in the
pretreatment period when women were actually engaged in the
decision-making process, whether they had declared a decision or
were still contemplating -- these thoughts were fresh and
appointments with physicians still ongoing," according to primary
investigator Robin Lally, PhD, RN, assistant professor of nursing
in the UB School of Nursing and adjunct assistant professor at
Roswell Park Cancer Institute.
One of the study's most interesting findings was that when women
were presented with options and felt they had control over their
choices they considered this to be a positive prognostic indicator
-- or an encouraging sign of their future survival. "Women reported
gaining confidence in their decision-making role through the
confidence and support they felt from their surgeon and staff,"
Lally said. "The women in the study valued receiving options, even
if they had one already in mind, and though they may not have seen
themselves as a person who is typically good at making decisions,
they drew confidence from the support provided to them by their
health care team while making the decision."
Most often, women's surgical treatment decision making has been
studied using a structured response format that limits the nature
of the answers by providing predetermined choices (multiple choice
or yes/no answers). This structured approach eliminates the context
in which decisions are made and limits women's ability to reveal
their thoughts behind how and why they make certain choices.
In contrast, the qualitative research approach used by Lally in
this study assembles participants who can provide rich insight and
expert knowledge on a particular phenomenon so that it can be
better understood in a real-world context.
"This research provides insight into what women newly diagnosed
with breast cancer may do, think about and expect even before they
see the surgeon at the clinic for the first time," Lally said.
Specifically, Lally's research showed that women felt that
information about breast cancer was important, but that they needed
to manage the amount and timing of the information they took in, in
order to prevent themselves from becoming overwhelmed. More was not
necessarily better. Some women preferred to use only the verbal
information provided by their care team on which to base their
decision and put the breast cancer literature away until just days
before their surgery.
Age was not a defining factor in how much information women
wanted or whether they used what was provided. Women of all ages
used information that answered their questions and tended to avoid
information that upset them emotionally.
Lally found that many women already had a plan in mind when they
entered the surgeon's office which they then weighed against the
surgeon's input. Their surgical treatment decisions were motivated
by the desire to: eliminate future inconvenience and worry about
cancer balanced by avoiding mastectomy unless medically required;
maintain physical function and appearance; and recover rapidly.
Most women felt that mastectomy should be reserved only for the
worst breast cancers. Older women saw advanced age as an advantage
-- age protected them from worry of recurrence and/or the
significant concern over loss of their breast although they still
Women of all ages expressed surprise that their surgeons did not
make a definitive recommendation, but that the choice of mastectomy
or lumpectomy was ultimately their own. Even women who wanted to
make their own decision still desired a recommendation from the
surgeon. When making a choice, however, they drew confidence from
the surgeons' support of their decision.
Lally hopes that surgeons and nurses will be inspired by her
findings to assess their breast cancer patients' expectations and
understanding regarding their options and the decision-making
process at the beginning of each consultation and be aware of the
important role providers play in supporting women's ability to make
Breast cancer survivors can also benefit from this research.
Lally hopes that, "survivors reading this study may find 'a little
of themselves' in the women's narratives and feel comforted in the
realization that others also had moments of feeling overwhelmed,
uncertain or surprised by the surgical decision-making process --
you are not alone."
Lally currently has a grant under review in collaboration with
Roswell Park Cancer Institute's Breast Center to study the thought
processes of African-American women in response to their breast
cancer diagnosis. She intends to use all of her research to develop
assessment and intervention tools for health care professionals in
order to identify women who may be at risk for ongoing distress
beyond this early time period.
The University at Buffalo is a premier research-intensive public
university, a flagship institution in the State University of New
York system and its largest and most comprehensive campus. The
School of Nursing is one of five schools that constitute UB's
Academic Health Center. UB's more than 28,000 students pursue their
academic interests through more than 300 undergraduate, graduate
and professional degree programs. Founded in 1846, the University
at Buffalo is a member of the Association of American