Torin Halsey/Times Record News via AP

January 6, 2017

A recent Pittsburgh Post-Gazette article looks at newly published research showing that, despite the recent surge of “preventive” double masectomies in the wake of Angelina Jolie’s publically announced decision to have this procedure, the recommendation of a woman’s surgeon’s is even more influential in this decision. Behavioral and Community Health Professor Dina Borzekowski, who researched the impact Ms. Jolie’s announcement had on the public’s understanding of double mastectomy surgery, said that this study is a call to “improve the patient-physician communication.”

The Pittsburgh Post-Gazette reports that the study, published in the America Medical Association Surgery journal, found that of 1,569 women surveyed in Los Angeles and Georgia with cancer in one breast but not a high genetic risk for the other, very few (just 1.9 percent) of them had a double mastectomy if their surgeon recommended against it.

However, the study found that many more women — nearly 1 in 5 (19 percent) — in the same group did have a double mastectomy if they got no recommendation from their surgeon.

“About a decade ago, we started to see this increase” in women having double mastectomies, said Dr. Reshma Jagsi, lead author of the study conducted at the University of Michigan. “We wanted to understand why it was that women were using this procedure, even though it is not likely to yield any medical benefits.”

The finding stunned Dr. Jagsi, a professor of radiation oncology at the University of Michigan who also treats breast cancer patients.

“We wanted to look at women [who had no recommendation from their surgeon] with average risk factors,” she said. “And even in that population we still saw that 14 percent of the population” was going through with a double mastectomy.

Their conclusion, she said: “A surgeon’s recommendation appears to be a very powerful factor here.”

“When it comes to understanding risk, the general populace does not get it,” Dr. Borzekowski says. “They don’t know what having a 1 in 4 chance means.” In 2014, Dr. Borzekowski’s research, “The Angelina effect: immediate reach, grasp, and impact of going public” found that, while three of four Americans were aware of Angelina Jolie’s double mastectomy, fewer than 10% of respondents had the information necessary to accurately interpret Ms. Jolie’s risk of developing cancer relative to a woman unaffected by the BRCA gene mutation. Awareness of the Angelina Jolie story was not associated with improved understanding. So, while celebrities can bring heightened awareness to health issues, there is a need for these messages to be accompanied by more purposeful communication efforts to assist the public in understanding and using the complex diagnostic and treatment information that these stories convey.

Dr. Jagsi’s new study adds another layer to our understanding of how patients obtain and evaluate information in order to make decisions about breast cancer. “It is going to fall to the informed physician” to give patients the information they need to make informed decisions, Tom Julian, a breast surgeon and division director for breast surgery at Allegheny Health Network, says. “And if we aren’t doing it well, we’ve got to come up with a way to improve it.”

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Surgeon’s recommendation often affects women’s breast cancer choices

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Dina Borzekowski