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Surgical Ethics pp 257–264Cite as

Ethics and Breast Cancer

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Abstract

Enabling, empowering and educating a woman to make the right choice between breast-conserving surgery and mastectomy are aligned with the fundamental principle of bioethics, that is, respect for patient autonomy. A clear understanding of the contemporary ethical and social issues related to genetic testing for breast cancer is necessary to develop a practical approach for counselling, testing and treating patients with genetic disposition to breast cancer. Ethnic inequities, disparities, opportunity and timeliness to treatment and its prognostic significance on breast cancer mortality have been studied in several populations worldwide. While the underutilisation of screening mammography can be attributed to socioeconomic and cultural and geographic barriers, ethical principles must be taken into account. The debate regarding no intervention for low-grade ductal carcinoma in situ and the issue of overdiagnosis are further ethical issues that raise concerns in the informed decision process and the ethical concepts of no harm and autonomy.

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References

  1. Kim C, Liang L, Wright FC, Hong NJL, Groot G, Helyer L, Meiers P, Quan ML, Urquhart R, Warburton R, Gagliardi AR. Interventions are needed to support patient-provider decision-making for DCIS: a scoping review. Breast Cancer Res Treat. 2018;168(3):579–92. https://doi.org/10.1007/s10549-017-4613-x.

    Article  PubMed  Google Scholar 

  2. Kennedy Report. Review of the response of Heart of England NHS Foundation Trust to concerns about Mr I Paterson’s Surgical Practice: lessons to be learned and recommendations.

    Google Scholar 

  3. Beauchamp TL, Childress JF. Respect for autonomy from the book principle of biomedical ethics. 7th edition. New York, Oxford: Oxford University press.

    Google Scholar 

  4. Mendick N, Young B, Holcombe C, Salmon P. The ethics of responsibility and ownership in decision-making about treatment for breast cancer. Triangulation of consultation with patient and surgeon’s perspective. Soc Sci Med. 2010;70(12):1904–11.

    Article  Google Scholar 

  5. Caldon L, Walters SJ, Reed MW. Changing trends in decision-making preferences of women with early breast cancer. The. Br J Surg. 2008;95(3):312–8.

    Article  CAS  Google Scholar 

  6. Dyers C. Woman who rejected breast cancer diagnosis may undergo surgery without her consent. BMJ. 2017;j5358:359.

    Google Scholar 

  7. Bernhardt BA, et al. Educating patients about cystic fibrosis carrier screening in a primary care setting. Archives of family medicine five; 1996. p. 336–40.

    Google Scholar 

  8. McKenzie C. Relational autonomy, normative authority and perfectionism. J Soc Philos. 2008;39:512–33.

    Article  Google Scholar 

  9. Bundred NJ, Thomas J, Dixon JMJ. Whither surgical quality assurance of breast cancer surgery (surgical margins and local recurrence) after Paterson. Breast Cancer Res Treat. 2017;165:473.

    Article  CAS  Google Scholar 

  10. Pusic AL, Matros E, Fine N, Buchel E, Gordillo GM, Hamill JB, Kim HM, Qi J, Albornoz C, Klassen AF, Wilkins EG. Patient-Reported Outcomes 1 Year After Immediate Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study. J Clin Oncol. 2017;35(22):2499–506.

    Article  Google Scholar 

  11. Association of Breast Surgery at BASO. Surgical guidelines for the management of breast cancer. Eur J Surg Oncol EJSO. 2009;1:1–22.

    Google Scholar 

  12. Fagerlin A, Lakhani I, Lantz PM, Janz NK, Morrow M, Schwartz K, Deapen D, Salem B, Liu L, Katz SJ. An informed decision? Breast cancer patients and their knowledge about treatment. Patient Educ Couns. 2006;64(1–3):303–12.

    Article  Google Scholar 

  13. Zdenkowski N, Butow P, Tesson S, Boyle FA. Systematic review of decision aids for patients making a decision about treatment for early breast cancer. Breast. 2016;26:31–45.

    Article  Google Scholar 

  14. Twomey M. Autonomy and reason: treatment choice in breast cancer. Eval Clin Pract. 2012;18(5):1045–50.

    Article  Google Scholar 

  15. Swainston K, Campbell C, van Wersch A, Durning P. Treatment decision-making in breast cancer: a longitudinal exploration of women’s experience. Lit Health Psychol. 2012;17(1):155–70.

    Google Scholar 

  16. Beauchamp TL, Childress JF. Principles of biomedical ethics. New York: Oxford University press; 2009.

    Google Scholar 

  17. Temple WJ, Russell ML, Parsons LL, et al. Conservation surgery for breast cancer as the preferred choice: a prospective analysis. J Clin Oncol. 2006;24:3367–73.

    Article  Google Scholar 

  18. Covelli AM, Baxter NN, Fitch MI, McCready DR, Wright FC. “Taking control of cancer”: understanding women’s choice for mastectomy. Ann Surg Oncol. 2015;22:383–91.

    Article  Google Scholar 

  19. Molenaar S, Oort F, Sprangers M, et al. Predictors of patients’ choices for breast-conserving therapy or mastectomy: a prospective study. Br J Cancer. 2004;90:2123–30.

    Article  CAS  Google Scholar 

  20. Keller J. Autonomy, relationality and feminist ethics. Hypatia. 1997;12:152–64.

    Article  Google Scholar 

  21. Jeffrey G, et al. Understanding women’s choice of mastectomy versus breast conserving therapy in early-stage breast cancer. Clin Med Insights Oncol. 2017;11:1179554917691266. PMC. Web. 19 Aug. 2018.

    Google Scholar 

  22. McVea KL, Minier WC, Johnson Palensky JE. Low-income women with early stage breast cancer: physician and patient decision-making styles. Psychooncology. 2001;10:137–46.

    Article  CAS  Google Scholar 

  23. Zikmund-Fisher BJ, Fagerlin A, Ubel PA. Risky feelings: why a 6% risk of cancer does not always feel like 6%. Patient Educ Couns. 2010;81:S87–93.

    Article  Google Scholar 

  24. Qullin JM, Lyckholm LJ. A principle-based approach to ethical issues in predictive genetic testing for breast cancer. Breast Dis. 2007;27(2006):137–48.

    Article  Google Scholar 

  25. Lanie AD, Jayaratne JP. Exploring the public understanding of basic genetic concept. J Gene Couns. 2004;13:305–20.

    Article  Google Scholar 

  26. McInerney J. Education in a genomic world. J Med Philos. 2002;27:369–90.

    Article  Google Scholar 

  27. National Society of genetic counsellors. NSGC: code of ethics.

    Google Scholar 

  28. Lo B. Overview of the doctor-patient relationship. In: Resolving ethical dilemmas: a guide for clinicians. 2nd ed. Philadelphia: Lippincott Williams & Williams; 2000. p. 195.

    Google Scholar 

  29. ASHG statement, professional disclosure of familiar genetic information. the American Society of human genetics social issue subcommittee unfamiliar disclosure. Am J Hum Genet. 1998;62:474–83.

    Google Scholar 

  30. Wilson BJ, Forrest K, van Teijlingen ER, McKee L, Haites N, Matthews E, Simpson SA. Family communication about genetic risk: the little that is known. Community Genet. 2004;7:15–24.

    PubMed  Google Scholar 

  31. Surbone A. Social and ethical implications of BRCA testing. Ann Oncol. 2011;22(Suppl 1):I 60–6.

    Article  Google Scholar 

  32. Surbone A. Balance between science and mortality. Ann Oncol. 2004;15(Suppl 1):i60–4.

    Article  Google Scholar 

  33. Jacobson N. The socially constructed breast: breast implants and the medical construction of need. Am J Public Health. 1998;88:1254–61.

    Article  CAS  Google Scholar 

  34. Eisinger F. Prophylactic mastectomy: ethical issues. Br Med Bull. 2007;81(82):7–19.

    Article  Google Scholar 

  35. Seneviratne S, Campbell I, Scott N, Lawrenson R. A cohort study of ethnic differences in use of adjuvant chemotherapy and radiation therapy for breast cancer in New Zealand. BMC Health Serv Res. 2017;17:64. https://doi.org/10.1186/s12913-017-2027-4PMCID.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Raphael MJ, Biagi JJ, Kong W, Mates M, Booth CM, Mackillop WJ. The relationship between time to initiation of adjuvant chemotherapy and survival in breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat. 2016;160(1):17–28.

    Article  CAS  Google Scholar 

  37. Al-Sukhun S, de Lima Lopes G Jr, Gospodarowicz M, Ginsburg O, Yu PP. Global Health Initiatives of the International Oncology Community. Am Soc Clin Oncol Educ Book. 2017;37:395–402. https://doi.org/10.14694/EDBK_100008.

    Article  PubMed  Google Scholar 

  38. Distelhorst SR, Cleary JF, Ganz PA, Bese N, Camacho-Rodriguez R, Cardoso F, Ddungu H, Gralow JR, Yip CH, Anderson BO. Optimisation of the continuum of supportive and palliative care for patients with breast cancer in low-income and middle-income countries: executive summary of the Breast Health Global Initiative, 2014. Breast Health Global Initiative Global Summit on Supportive Care and Quality of Life Consensus Panel Members. Lancet Oncol. 2015;16(3):e137–47.

    Article  Google Scholar 

  39. O’Mahony M, Comber H, Fitzgerald T, Corrigan MA, Fitzgerald E, Grunfeld EA, Flynn MG, Hegarty J. Interventions for raising breast cancer awareness in women. Cochrane Database Syst Rev. 2017;2:CD011396.

    PubMed  Google Scholar 

  40. Abulkhair O, Saghir N, Sedky L, Saadedin A, Elzahwary H, Siddiqui N, Al Saleh M, Geara F, Birido N, Al-Eissa N, Al Sukhun S, Abdulkareem H, Ayoub MM, Deirawan F, Fayaz S, Kandil A, Khatib S, El-Mistiri M, Salem D, Sayd el SH, Jaloudi M, Jahanzeb M, Gradishar WI. Modification and implementation of NCCN guidelines on breast cancer in the Middle East and North Africa region. MENA Breast Cancer Regional Guidelines Committee. J Natl Compr Cancer Netw. 2010;8(Suppl 3):S8–S15.

    Article  Google Scholar 

  41. Kobetz E, Mendoza AD, Barton B, Menard J, Allen G, Pierre L, Diem J, McCoy V, McCoy C. Mammography use among Haitian women in Miami, Florida: an opportunity for intervention. J Immigr Minor Health. 2010;12(3):418–21.

    Article  Google Scholar 

  42. Parker L, Carter S, Williams J, Pickles K, Barratt A. Avoiding harm and supporting autonomy are under-prioritised in cancer-screening policies and practices. Eur J Cancer. 2017;85:1–5. https://doi.org/10.1016/j.ejca.2017.07.056.

    Article  PubMed  Google Scholar 

  43. Parker L. Including values in evidence-based policy making for breast screening: An empirically grounded tool to assist expert decision makers. Health Policy. 2017;121(7):793–9. https://doi.org/10.1016/j.healthpol.2017.03.002.

    Article  PubMed  Google Scholar 

  44. Francis A, Thomas J, Fallowfield L, et al. Addressing overtreatment of screen detected DCIS; the LORIS trial. Eur J Cancer. 2015;51(16):2296–30.

    Article  Google Scholar 

  45. Elshof LE, Tryfonidis K, Slaets L, et al. Feasibility of a prospective, randomised, open-label, international multicentre, phase III, non-inferiority trial to assess the safety of active surveillance for low risk ductal carcinoma in situ - The LORD study. Eur J Cancer. 2015;51(12):1497–510.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. University Hospitals of Derby and Burton NHS Foundation Trust, Queens Hospital, Burton-on-Trent, UK

    Amtul R. Carmichael

  2. University of Aston, Birmingham, UK

    Amtul R. Carmichael

  3. Department of Molecular Medicine and Surgery, Karolinska Insitutet, Stockholm, Sweden

    Kerstin Sandelin

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  1. Amtul R. Carmichael
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  2. Kerstin Sandelin
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Correspondence to Amtul R. Carmichael .

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Editors and Affiliations

  1. Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina

    Alberto R. Ferreres

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Carmichael, A.R., Sandelin, K. (2019). Ethics and Breast Cancer. In: Ferreres, A. (eds) Surgical Ethics. Springer, Cham. https://doi.org/10.1007/978-3-030-05964-4_24

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  • DOI: https://doi.org/10.1007/978-3-030-05964-4_24

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  • Print ISBN: 978-3-030-05963-7

  • Online ISBN: 978-3-030-05964-4

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