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Clinicopathologic factors and patient perceptions associated with surgical breast-conserving treatment

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Abstract

Background: Clinical studies have shown equivalent survival rates between breast-conserving surgery (BCS) and mastectomy in early breast cancer; however, rates for BCS remain low. The purpose of this study was to determine (a) the prevalence of BCS in a regional medical center, (b) clinicopathologic factors associated with BCS, and (c) patient perceptions of the treatment decision-making process.

Methods: We retrospectively reviewed 251 consecutive breast cancer cases during January 1990–December 1991; 77 patients were ineligible for BCS because of unfavorable pathology. We then interviewed 118 of the 160 women available for interview.

Results: BCS was performed in 31 of the eligible patients (18%). Multivariate analysis revealed that tumor size <10 mm (p=0.03) was the only significant predictive variable for BCS. Patient interviews revealed that 93% said their surgeon was the primary source of information regarding treatment options. Among 69% of the women whose surgeons reportedly recommended a particular option, 89% recommended mastectomy with 93% compliance, and 11% recommended BCS with 89% compliance. The BCS group more often obtained a second opinion (p=0.04) and 60% said they made the decision themselves compared with only 37% of the mastectomy group (p=0.05).

Conclusion: Limiting BCS to women whose tumor size is <10 mm is too restrictive; this excludes a large number of women who are clinically eligible for BCS. The surgical decision-making process for early-stage breast cancer is very much surgeon-driven, with a high degree of patient compliance.

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Authors and Affiliations

  1. From the Departments of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Cyrus A. Kotwall MD & J. Gary Maxwell MD

  2. New Hanover Regional Medical Center, Wilmington, North Carolina, USA

    Cyrus A. Kotwall MD, J. Gary Maxwell MD, Deborah L. Covington MS, Paige Churchill BA & Susan E. Smith MD

  3. Coastal Area Health Education Center, Wilmington, North Carolina, USA

    Cyrus A. Kotwall MD, J. Gary Maxwell MD & Susan E. Smith MD

  4. University of North Carolina at Wilmington, Wilmington, North Carolina, USA

    Eleanor Krassen Covan PhD

Authors
  1. Cyrus A. Kotwall MD
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  2. J. Gary Maxwell MD
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  3. Deborah L. Covington MS
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  4. Paige Churchill BA
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  5. Susan E. Smith MD
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  6. Eleanor Krassen Covan PhD
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Kotwall, C.A., Maxwell, J.G., Covington, D.L. et al. Clinicopathologic factors and patient perceptions associated with surgical breast-conserving treatment. Annals of Surgical Oncology 3, 169–175 (1996). https://doi.org/10.1007/BF02305797

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  • DOI: https://doi.org/10.1007/BF02305797

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