Breast cancer: alternatives to mastectomy.

• Author: Finn, Kristen Lidke

Studies show that lumpectomy, in which just the tumor and a layer of surrounding tissue are removed, is an effective option when combined with radiation therapy.

THE BIOPSY comes back positive--it's breast cancer. One and a half million American women will be hit with such news this decade. Many of those whose cancer is detected early also will face one of the hardest decisions of their lives: whether to have a mastectomy or a lumpectomy followed by several weeks of radiation therapy.

Health care professionals can offer sympathy, support groups, and survival statistics, but, in the end, it is the women who must make the decision. "These women are largely on their own when it comes to deciding what to do at a time when they're least prepared emotionally to do so," notes Penny Pierce, assistant professor of nursing, University of Michigan.

Upon hearing that they have cancer, many women describe being mentally and emotionally clouded and unable to think, Pierce explains. "They say, `I could see the doctor's mouth moving, but I was somewhere else: I didn't hear a thing that was said to me.' They describe this complete fog that comes over them ... they project themselves into a different place and time and worry about what's going to happen to their children." Soon, if not immediately after hearing the diagnosis, these women are asked to make a choice about treatment--at a time when they have few emotional resources upon which to draw.

"For some women, the process of making a quality decision is more emotionally draining than the diagnosis of breast cancer itself," indicates Pierce, who in 1985 was the first in the nation to study the decision-making experiences of women with early-stage breast cancer. While her initial study involved about 50 breast cancer patients, she since has expanded her research to include hundreds of healthy women to find out what type of breast cancer treatment they most likely would pursue, and why. By better understanding how women make life-altering choices in the face of often-conflicting information and emotional turmoil, Pierce hopes to develop practical clinical guidelines to help patients and their caregivers deal with the grueling decision-making process.

Until about five years ago, they didn't have the luxury of choice. A breast cancer diagnosis almost always meant mastectomy--the removal of the breast and its adjacent lymph nodes--followed by reconstructive surgery. Up to 70% of operable breast cancer cases...