The Uptake and Factors Associated with Mastectomy among Chinese Women with Breast Cancer: A Retrospective Observational Study

Abstract

Objective: There are limited data concerning the use of mastectomy and associated factors in China in recent years. This study aimed to investigate the uptake of mastectomy and determine the associations between patients' characteristics and mastectomy among Chinese women with breast cancer. Methods: A retrospective analysis of female breast cancer cases from January 2015 to December 2019 from a tertiary hospital was conducted. Socio-demographic data, clinical data, and surgery types were collected by reviewing the medical record system. Chi-square test, Fisher's exact test and multivariate logistic regression analysis were used to determine correlations of patients' characteristics with mastectomy. Results: A total of 1,171 women with breast cancer were identified, and 76.60% of them underwent a mastectomy. The mastectomy rates showed an increase from 70.62% in 2015 to 86.87% in 2017 and then dropped to 71.91% in 2019. Women undergoing mastectomy were older and were more likely to be married and have at least one child. They had an advanced cancer stage, larger tumour size, and more positive lymph nodes and were HER-2-overexpressing. Older age, larger tumour size (2-5 cm), higher cancer stages (stage 2-stage 3) and being positive for HER-2 were the four independent variables that significantly predicted the uptake of mastectomy. Conclusions: Our results showed a wide application of mastectomy in China and uncovered the factors associated with mastectomy uptake from a single-centre experience. Findings suggested the potential overuse of mastectomy among women with early-stage breast cancer, and highlighted the significance of promoting cancer screening in China. Findings could be also used to develop relevant provisions and interventions to facilitate breast cancer treatment decision-making and screening planning.

Current Trends in Breast Cancer Treatment in Chinese and Chinese American Women

“…Interestingly, younger NC women harbor significant concerns about breast value and femininity, and are therefore more likely to pursue breast reconstruction. Zhang et al 40 reported that 35.3% of patients believed that “breast conservation is not necessary for old people.” 6,15,31,41 …”

“…Zhang et al 40 reported that 35.3% of patients believed that "breast conservation is not necessary for old people." 6,15,31,41 Marital status and social support were found to be 2 of the main factors that affected the acceptance of reconstruction in one study. 41 In particular, husbands were again some of the most influential players, with 39.6% suggesting that their wives choose a mastectomy.…”

“…Currently, in both the United States and China, the surgical treatment of breast cancer includes mastectomy with the option of reconstruction. However, both CA and native Chinese (NC) patients report remarkably high levels of mastectomies without reconstruction 5,6 . Although there has been evidence that socioeconomic differences may impact the quality of care these patients receive, in-depth analyses suggest that cultural values may also sway patients' decisions.…”

“How can a woman live without having a breast?”: challenges related to mastectomy in Ethiopia

“…Another quantitative study also identified that older age (≥ 65 years) was one of factors for refusal of mastectomy among male breast cancer patients [ 3 ]. In contrast, women undergoing mastectomy in China were older and more likely to be married and have at least one child [ 31 ].…”

Decision‐making experiences related to mastectomy: A descriptive qualitative study

“…The low reconstruction rates after mastectomy could be associated with various factors, including ethnicity, low socioeconomic status, the unavailability of this surgery, and personal reasons such as fear of additional surgery and implants (Morrow et al., 2014; Restrepo et al., 2019). In addition, although breast‐conserving surgery (BCS) is increasingly recommended for early breast cancer as a more favorable procedure than mastectomy due to its similar survival rates and better cosmetic results (Fisher et al., 2002; Veronesi et al., 2002), a large percentage of women with early breast cancer still undergo a mastectomy in many countries (Liu, Guo, et al., 2021; Sinnadurai et al., 2018). Understanding women's decision‐making experiences regarding mastectomy is thus important to provide support to these women during this process.…”