A study in the October 14 issue of JAMA, a theme issue on surgical care says that a survey of nearly 2,000 women indicates that breast-conserving surgery was attempted as the initial therapy for about 75 percent of those surveyed.

Monica Morrow, M.D., of Memorial Sloan-Kettering Cancer Center, New York, presented the findings of the study at a JAMA media briefing in Chicago.

"Concerns about excessive use of mastectomy for patients with breast cancer have been raised for more than 2 decades. Rates of breast-conserving surgery (BCS) have been used by some as a quality measure. Despite a marked increase in BCS, concerns persist that women with breast cancer are being overtreated with mastectomy," according to background information in the article.

Dr. Morrow and colleagues conducted a study to determine the reasons women undergo initial mastectomy for treatment of breast cancer and the frequency of mastectomy after BCS is attempted. The study consisted of a survey of women age 20 to 79 years with intraductal or stage I and II breast cancer diagnosed between June 2005 and February 2007 and reported to the National Cancer Institute's Surveillance, Epidemiology, and End Results registries for the metropolitan areas of Los Angeles and Detroit. The final survey sample included 1,984 female patients (502 Latinas, 529 blacks, and 953 non-Hispanic white or other).

The researchers found that of the patient population, 75.4 percent had BCS as an initial surgical therapy; 23 percent had initial mastectomy; 13.4 percent received initial mastectomy based on surgeon recommendation; 8.8 percent received initial mastectomy when the first surgeon did not recommend one procedure over another or recommended BCS; and 8.8 percent received mastectomy after unsuccessful attempts at BCS.