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.
Breast cancer Surgery Segmental mastectomy Breast-conserving surgery Patient interview
Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer.N Engl J Med 1989;320:822–8.PubMedGoogle Scholar
Veronesi U, Banfi A, Del Vecchio M, et al. Comparison of Halstead mastectomy with quadrantectomy, axillary dissection and radiotherapy in early breast cancer: long-term results.Eur J Cancer Clin Oncol 1986;22:1085.PubMedGoogle Scholar
Sarrazin D, Le MG, Arriagada R, et al. Ten-year results of a randomized trial comparing a conservative treatment to mastectomy in early breast cancer.Radiother Oncol 1989;14:177–84.CrossRefPubMedGoogle Scholar
NIH Consensus Conference. Treatment of early-stage breast cancer.JAMA 1991;265:391–5.Google Scholar
Farrow DC, Hunt WC, Samet JM. Geographic variation in the treatment of localized breast cancer.N Engl J Med 1992;326:1097–101.PubMedGoogle Scholar
Nattinger AB, Gottlieb MS, Veum J, Yahnke D, Goodwin JS. Geographic variation in the use of breast-conserving treatment for breast cancer.N Engl J Med 1992;326:1102–7.PubMedGoogle Scholar
Osteen RT. Breast cancer. In: Steele GD, Osteen RT, Winchester DP, Menck HR, Murphy GP, ed.National cancer data base annual review of patient care — 1994. Atlanta: American Cancer Society, 1994:56–71.Google Scholar
Schain WS. Physician-patient communication about breast cancer: a challenge for the 1990's.Surg Clin North Am 1990;70:917–36.PubMedGoogle Scholar
Liberati A, Patterson WB, Biener L, McNeil BJ. Determinants of physicians' preferences for alternative treatments in women with early breast cancer.Tumori 1987;73:601–9.PubMedGoogle Scholar
Liberati A, Apolune G, Nicolucci A, et al. The role of attitudes, beliefs, and personal characteristics of Italian physicians in the surgical treatment of early breast cancer.Am J Public Health 1991;81:38–42.PubMedGoogle Scholar
Deber RB, Thompson GG. Who still prefers aggressive surgery for breast cancer? Implications for the clinical applications of clinical trials.Arch Intern Med 1987;147:1543–7.CrossRefPubMedGoogle Scholar
Tarbox BB, Rockwood JK, Abernathy CM. Are modified radical mastectomies done for T1 breast cancers because of surgeon's advice or patient's choice?Am J Surg 1992;164:417–22.PubMedGoogle Scholar
Palmer ML. Reluctance for conservative surgery and radiation for early breast cancer.Surg Rounds 1994;17:51–4.Google Scholar