Factors that Affect Patients’ Decision-Making about Mastectomy or Breast Conserving Surgery, and the Psychological Effect of this Choice on Breast Cancer Patients

Abstract

Background: Breast cancer is the most common cancer in women. Primary treatment is surgery, with breast conserving surgery (BCS) being widely used for early-stage disease. Due to changes in body image, depressive symptoms can occur after surgery. Here, we evaluate factors that affect patients’ decision on surgery, and investigate differences in the level of depression after mastectomy or BCS in a population of Turkish patients. Patients and Methods: One hundred breast cancer patients who had undergone mastectomy or BCS and were followed up at our institution between 2007 and 2008 were included. Patients were questioned about their involvement in surgical decision-making. Depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria via a Structural Clinical Interview for DSM (SCID). Severity of depression was evaluated by using the Beck Depression Inventory (BDI). Results: Patients who were older than 50 years, had more than 1 child, a history of lactation, and a positive family history of breast cancer mostly preferred mastectomy. However, patients who sought a second opinion and further information on BCS preferred BCS (p < 0.005). There was no statistical correlation between marital status, first childbearing age, and educational status and the decision on surgery type (p > 0.005). Mastectomy patients were prone to depression, but this was not statistically significant (p = 0.099). Conclusion: Age, parenthood, lactation, and positive familial history, as well as thorough information about the type of surgery were important factors for the patients’ decision. After breast cancer surgery, patients might experience depression affecting treatment and quality of life. Therefore, adequate information and communication are essential.

Patients' Perspective: What has Changed in Deciding about Breast-Conserving Surgery for Early-Stage Breast Cancer in Turkey?

“…In patriarchal societies, it is known that family members, especially husbands, are highly influential in the decision phase. A study conducted in Turkey in 2010 showed that married women were likely to prefer BCS due to concerns of losing their spouse [15]. After 7 years, our study revealed that BCS preference is higher among single women than among married patients.…”

“…A study from 2010 reported that patients considered mastectomy as being oncologically safer than BCS and thus mastectomy rates were higher than BCS rates [15]. Since then, experience with BCS has increased, multidisciplinary approaches have become standard of care, intraoperative surgical margin assessment techniques have developed, and in experienced and well-equipped centers local recurrence rates have decreased to almost 1% with BCS.…”

Factors Associated with the Adoption of Minimally Invasive Radical Prostatectomy in the United States

“…19 Similarly, obtaining second opinions has altered surgical treatment in breast cancer, as women visiting a second surgeon have been shown to be more likely to undergo breast conserving surgery vs radical mastectomy. 11 Younger surgeons (younger than 50 years) were 2.5 times more likely to use MIRP. Current urological training exposes younger trainees to more minimally invasive procedures and, therefore, younger surgeons are likely more inclined to offer MIRP vs RRP.…”

“…For example, patient age, parity and family history were significant determinants for undergoing breast conserving surgery vs mastectomy for breast cancer. 11 In addition, among patients undergoing anterior cruciate ligament reconstruction, those who conducted significant Internet based research or had higher levels of education were more likely to choose allografts vs autografts. 12 Surgeon level characteristics also contributed to variability in the selection of MIRP vs RRP, although to a lesser extent than patient level characteristics.…”

Exploring Factors that Influence the Choice to Retire from Driving in Older Adults

“…Globally, emotions affect choice either positively or negatively (Baker, 2006;Burge & Street, 2010;Federman, Wisinversky, Wolf, Leventhal, & Halm, 2010;Goodwin, Zhang, & Ostir, 2004;Gumus et al, 2010;Gurland, & Gurland(a), 2009;Joon, Kim, Shanker, & Han, 2004;Matsuoka et al, 2011;Visser et al, 2009;Wang, Novemsky, Dhar, & Baumeister, 2010). Yet, the underpinnings of the relationship between choice and depressive symptoms arise from the interrelationship between choice, independence, and retirement, and therefore, these interrelationships require closer examination.…”