Influences on decision for mastectomy in patients eligible for breast conserving surgery

Rippy, Elisabeth; Ainsworth, Rachel; Sathananthan, Dharshan; Kollias, James; Bochner, Melissa; Whitfield, Robert J.

doi:10.1016/j.breast.2013.12.009

Cited by 29 publications

(45 citation statements)

References 27 publications

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“…These findings support the literature that has found tumour pathology is an influencing factor behind a patient's decision for surgery, specifically larger tumour size, higher-grade tumours and positive axillary staging (3,6,7,22). Importantly, the published studies do not make it clear whether the tumour data relates to pre-operative or post-operative findings.…”

Section: Discussioncontrasting

confidence: 31%

Factors associated with patients in the Scottish Highlands who chose mastectomy when suitable for breast conservation

et al. 2016

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Background: Despite being suitable for breast conservation surgery (BCS) a proportion of women choose mastectomy. This study aimed to assess the pre-operative pathological and geographic factors associated with choosing mastectomy rather than BCS in a single centre that serves a large geographical area encompassing urban, rural and remote island populations.Methods: A retrospective analysis of all patients suitable for BCS between January 2011 and December 2013 was undertaken. Pre-operative pathological features were compared using the Pearson chi squared test as was distance to the treatment centre from the patient's home. A questionnaire was sent to all those who chose mastectomy to identify the factors that influenced their decision. Patients choosing mastectomy were more likely to live remotely (P=0.051). Those patients who chose mastectomy felt this gave a better long-term outcome (18 patients, 44%) and peace of mind (14 patients, 34%).Conclusions: Adverse pre-operative pathological features were associated with patients choosing mastectomy rather than BCS. There was a trend for patients who chose mastectomy to live remotely from the treatment centre. Patients choosing mastectomy most commonly cited a better long-term outcome and peace of mind as the reason behind their decision. Understanding what influences a patient's surgical choice will allow clinicians and patients to engage in a fully informed pre-operative decision making process.

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Section: Discussioncontrasting

confidence: 31%

Factors associated with patients in the Scottish Highlands who chose mastectomy when suitable for breast conservation

et al. 2016

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“…Surgeon preferences and manner of communicating recommendations have been considered a significant factor in influencing patients' decision-making processes and eventual choice of surgery (Woon and Chan, 2005;Dixon and Mak, 2008;Rippy et al, 2014). Data from the current study supports these theories.…”

Section: Discussionsupporting

confidence: 72%

Evaluation of Eligibility and Utilization of Breast Conservation Treatment in an Asian Context

Tan¹,

Sitoh²,

Sim³

2014

Asian Pacific Journal of Cancer Prevention

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“…Rural residency is known to influence delay as well as a woman’s decision to undergo adjuvant radiation therapy for breast cancer [32]. Radiation therapy requires women to attend a radiation facility five days a week over a period ranging from three to six consecutive weeks and due to this many rural women prefer mastectomy over BCS [14, 32].…”

Section: Discussionmentioning

confidence: 99%

“…Radiation therapy requires women to attend a radiation facility five days a week over a period ranging from three to six consecutive weeks and due to this many rural women prefer mastectomy over BCS [14, 32]. This is of greater importance for the study women as the Waikato district health board covers an area of over 20,000 square kilometres and yet has provided radiation therapy services through a single central facility.…”

Section: Discussionmentioning

confidence: 99%

Ethnic differences in timely adjuvant chemotherapy and radiation therapy for breast cancer in New Zealand: a cohort study

Seneviratne

Campbell

Scott³

et al. 2014

BMC Cancer

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BackgroundIndigenous and/or minority ethnic women are known to experience longer delays for treatment of breast cancer, which has been shown to contribute to ethnic inequities in breast cancer mortality. We examined factors associated with delay in adjuvant chemotherapy and radiotherapy for breast cancer, and its impact on the mortality inequity between Indigenous Māori and European women in New Zealand.MethodsAll women with newly diagnosed invasive non-metastatic breast cancer diagnosed during 1999–2012, who underwent adjuvant chemotherapy (n = 922) or radiation therapy (n = 996) as first adjuvant therapy after surgery were identified from the Waikato breast cancer register. Factors associated with delay in adjuvant chemotherapy (60-day threshold) and radiation therapy (90-day threshold) were analysed in univariate and multivariate models. Association between delay in adjuvant therapy and breast cancer mortality were explored in Cox regression models.ResultsOverall, 32.4% and 32.3% women experienced delays longer than thresholds for chemotherapy and radiotherapy, respectively. Higher proportions of Māori compared with NZ European women experienced delays longer than thresholds for adjuvant radiation therapy (39.8% vs. 30.6%, p = 0.045) and chemotherapy (37.3% vs. 30.5%, p = 0.103). Rural compared with urban residency, requiring a surgical re-excision and treatment in public compared with private hospitals were associated with significantly longer delays (p < 0.05) for adjuvant therapy in the multivariate model. Breast cancer mortality was significantly higher for women with a delay in initiating first adjuvant therapy (hazard ratio [HR] =1.45, 95% confidence interval [CI] 1.05-2.01). Mortality risks were higher for women with delays in chemotherapy (HR = 1.34, 95% CI 0.89-2.01) or radiation therapy (HR = 1.28, 95% CI 0.68-2.40), although these were statistically non-significant.ConclusionsIndigenous Māori women appeared to experience longer delays for adjuvant breast cancer treatment, which may be contributing towards higher breast cancer mortality in Māori compared with NZ European women. Measures to reduce delay in adjuvant therapy may reduce ethnic inequities and improve breast cancer outcomes for all women with breast cancer in New Zealand.

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Influences on decision for mastectomy in patients eligible for breast conserving surgery

Cited by 29 publications

References 27 publications

Factors associated with patients in the Scottish Highlands who chose mastectomy when suitable for breast conservation

Factors associated with patients in the Scottish Highlands who chose mastectomy when suitable for breast conservation

Evaluation of Eligibility and Utilization of Breast Conservation Treatment in an Asian Context

Ethnic differences in timely adjuvant chemotherapy and radiation therapy for breast cancer in New Zealand: a cohort study

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