According to pub­lished reports from the Insti­tute of Med­i­cine and the New Eng­land Journal of Med­i­cine, roughly one-​​third of early-​​stage breast cancer patients undergo mas­tec­tomy even though breast con­ser­va­tion surgery with radi­a­tion therapy results in equal sur­vival rates.

The find­ings, said Sheryl Mendlinger, an admin­is­tra­tive man­ager at the Insti­tute on Urban Health Research in the Bouvé Col­lege of Health Sci­ences at North­eastern Uni­ver­sity, sug­gest that patients lack knowl­edge or don’t ade­quately par­tic­i­pate in the decision-​​making process.

Her new report — pub­lished in the Jan­uary edi­tion of The Breast Journal and co-​​authored by researchers at Har­vard Med­ical School, Brigham and Women’s Hos­pital and the Dana-​​Farber Cancer Insti­tute — out­lines a model of knowl­edge acqui­si­tion in newly diag­nosed breast cancer patients.

The report grew out of Mendlinger’s doc­toral dis­ser­ta­tion on how young women acquire knowl­edge about menstruation.

The goal is to gain a better under­standing of the process that women go through when they are faced with breast cancer and have to deal with the shocking news and make impor­tant deci­sions in a rel­a­tively short period of time,” Mendlinger explained. “We really want to under­stand why more women would not choose a less rad­ical surgery that is easier to recover from and has the same sur­vival rate.”

As the co-​​authors put it in the report, “In order for a patient to ade­quately par­tic­i­pate in the decision-​​making process, she must acquire new knowledge.”

The paper high­lights four types of knowl­edge acqui­si­tion: author­i­ta­tive, tech­nical, embodied and traditional.

Author­i­ta­tive knowl­edge, Mendlinger said, is that which is pro­vided by fig­ures of authority, such as breast sur­geons and med­ical oncol­o­gists. Tech­nical knowl­edge, which is also acquired from health-​​care spe­cial­ists, refers to an under­standing of both clin­ical pro­ce­dures and the health-​​care system. Embodied knowl­edge is gath­ered from observing friends, rel­a­tives or peers who have gone through sim­ilar expe­ri­ences. Tra­di­tional knowl­edge is that which is trans­mitted between gen­er­a­tions through rit­uals and history.

Mendlinger, a two-​​time breast cancer sur­vivor, has relied on author­i­ta­tive, tech­nical and embodied knowl­edge to make her decisions.

The model’s effec­tive­ness, she noted, is not lim­ited to breast cancer patients. “It could help anyone faced with any kind of health issue,” Mendlinger explained.

She and her col­leagues at Har­vard Med­ical School and the Brigham are preparing to apply for a grant from National Insti­tutes of Health to study how early-​​stage breast cancer patients make their decisions.

One of the impor­tant goals is to find out what role health-​​care providers play in the process and to develop edu­ca­tion tools or mate­rials for doc­tors and patients,” Mendlinger said.