Factors influencing patient decision-making between simple mastectomy and surgical alternatives

Abstract

BackgroundDespite similar survival rates, breast‐conserving therapy (BCT) remains a distant second choice after simple mastectomy for patients with early‐stage breast cancer in Singapore. Uptake of reconstruction after mastectomy is also low (18 per cent). The aim of this study was to explore the factors influencing a patient's choice for mastectomy when eligible for BCT, and why patients decline reconstruction after mastectomy.MethodsPatients from the National Cancer Centre Singapore, who were eligible for BCT but chose mastectomy without reconstruction, between December 2014 and December 2015 were included. An interviewer‐administered questionnaire focusing on patients' reasons for choosing mastectomy over BCT and not opting for immediate breast reconstruction after mastectomy was used. Tumour characteristics were retrieved from medical records. Spearman's rank correlation coefficient, Mann–Whitney U and Kruskal–Wallis tests were used to analyse the correlation between the patient's self‐rated influential factors and variables. Statistical significance was taken as P < 0·050.ResultsNinety‐one patients were included (90·1 per cent response rate). The main reasons for choosing mastectomy over BCT were: fear of cancer recurrence (considered very important in 74 per cent), the perception that health outweighs breast retention (49 per cent) and the possibility of second surgery for margins (40 per cent). Key factors for rejecting immediate reconstruction after mastectomy were: patient‐perceived ‘old age’ (very important in 53 per cent), concern about two sites of surgery (42 per cent) and financial cost (29 per cent). Given a second chance, 19·8 per cent of patients would undergo BCT instead of mastectomy.ConclusionThis study has identified the considerations that women in Singapore have when deciding on breast cancer surgery. Some perceptions need to be addressed for women to make a fully informed decision, especially as one‐fifth regret their initial choice.

Mastectomy or Breast-Conserving Therapy for Early Breast Cancer in Real-Life Clinical Practice: Outcome Comparison of 7565 Cases

“…Treatment of early-stage breast cancer can be considered as a preference-sensitive setting, where decision-making between treatment options can change according to patient preferences [7]. Typical factors able to influence the therapeutic choice in favor of mastectomy include: (i) concerns regarding cancer recurrence, (ii) perception that health outweighs breast retention [8], or (iii) perceived consequences of BCT, including potential adverse effects of radiation therapy [7,9]. Moreover, a renewed interest and trend towards mastectomy has recently emerged, with an increased use of skin-sparing or nipple-sparing mastectomies with immediate breast reconstruction [10,11,12].…”

Impact of hormonal status on ductal carcinoma in situ of the breast: Outcome and prognostic factors

“…This disproportionally higher rate of mastectomy in our population has been observed in our Asian ladies with breast cancer, across the different stages . The reasons for this are multifactorial, including small average breast volume, and increased uptake of post‐mastectomy reconstruction and cultural and social differences between the East and the West …”

Breast conserving surgery versus modified radical mastectomy

“…Younger patients tend to opt for BCT, while older patients frequently prefer radical mastectomy. The main reasons for choosing mastectomy over BCT were fear of cancer recurrence, the perception that health outweighs breast retention and the possibility of second surgery for margins [7]. Key factors for rejecting immediate reconstruction after mastectomy were patient-perceived "old age", concern about two sites of surgery, and financial cost [7].…”

“…The main reasons for choosing mastectomy over BCT were fear of cancer recurrence, the perception that health outweighs breast retention and the possibility of second surgery for margins [7]. Key factors for rejecting immediate reconstruction after mastectomy were patient-perceived "old age", concern about two sites of surgery, and financial cost [7]. Given a second chance, many patients would undergo BCT instead of mastectomy [7].…”

“…Key factors for rejecting immediate reconstruction after mastectomy were patient-perceived "old age", concern about two sites of surgery, and financial cost [7]. Given a second chance, many patients would undergo BCT instead of mastectomy [7].…”