World Journal of Surgery

, 32:2549 | Cite as

Breast-Conserving Surgery in Hong Kong Chinese Women

  • Dacita Suen
  • Lorraine Chow
  • Ava KwongEmail author



Since the introduction of breast-conserving surgery (BCS), it has been increasingly accepted as the standard surgical option for suitable breast cancer patients in Western countries. However, there have been reports suggesting striking ethnic variations in those undergoing BCS. This study aimed to review the rate of BCS in Hong Kong Chinese breast cancer patients and the possible clinicopathologic and psychosocial factors that may have affected the choice of surgery.


Patients in a university academic surgical center with early-stage breast cancer (stage I/II invasive carcinoma and carcinoma in situ) who underwent definitive surgery from January 2001 to December 2005 were studied. BCS was considered feasible for those with (1) the optimal tumor size for which an acceptable cosmetic outcome can be achieved after surgery, (2) unifocal disease, and (3) no contraindication for postoperative radiotherapy. The proportion of women undergoing BCS or mastectomy were compared. Factors affecting the choice of surgery were correlated.


Six hundred eighty female patients with early-stage breast cancer underwent surgery during the study period; 495 (72.8%) mastectomies, 149 (21.9%) BCS, and 36 (5.3%) mastectomies with immediate reconstruction were performed. For those patients who had mastectomies, 54.8% (271/495) had considered BCS as the initial surgical option. Among these, 19.6% (53/271) failed to have BCS performed due to margin involvement or extensive disease, and 80.4% (218/271) declined BCS and opted for mastectomy only. Age, marital status, and educational level were found to be independent significant factors affecting the choice of BCS.


The rate of BCS in Hong Kong is relatively low compared to that of Western countries. Patients who opted for mastectomies tended to be older, married, and have a lower educational level. Prospective studies on how sociocultural, clinicopathologic, and other factors important in treatment decision-making processes and psychosocial impact of choice of surgery are important so that an ethnic-specific assessment can be made. Suitability and acceptance of BCS by Chinese women should increase with better understanding and education.


Breast Cancer Chinese Woman Breast Conservation Margin Involvement Psychosocial Sequela 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    NIH Consensus Conference (1991) Treatment of early-stage breast cancer. JAMA 265:391–395CrossRefGoogle Scholar
  2. 2.
    Levy SM, Herberman RB, Lee JK et al (1989) Breast conservation versus mastectomy: distress sequelae as a function of choice. J Clin Oncol 7:367–375PubMedGoogle Scholar
  3. 3.
    Margolis GJ, Goodman RL, Rubin A et al (1989) Psychological factors in the choice of treatment for breast cancer. Psychosomatics 30:192–197PubMedGoogle Scholar
  4. 4.
    Schain WS, Fetting JH (1992) Modified radical mastectomy versus breast conservation: psychosocial considerations. Semin Oncol 19(3):239–243PubMedGoogle Scholar
  5. 5.
    Moyer A (1997) Psychosocial outcomes of breast-conserving surgery versus mastectomy: a meta-analytic review. Health Psychol 16(3):284–298PubMedCrossRefGoogle Scholar
  6. 6.
    Gomez SL, France AM, Lee MM (2004) Socioeconomic status, immigration/acculturation, and ethnic variations in breast conserving surgery, San Francisco Bay area. Ethn Dis 14:134–140PubMedGoogle Scholar
  7. 7.
    Morris CR, Cohen R, Schlag R et al (2000) Increasing trends in the use of breast-conserving surgery in California. Am J Public Health 90:281–284PubMedCrossRefGoogle Scholar
  8. 8.
    Prehn AW, Topol B, Stewart S et al (2002) Differences in treatment patterns for localized breast carcinoma among Asian/Pacific Islander women. Cancer 95:2268–2275PubMedCrossRefGoogle Scholar
  9. 9.
    Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347(16):1227–1232 PubMedCrossRefGoogle Scholar
  10. 10.
    Fisher B, Jeong JH, Anderson S et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347(16):1233–1241PubMedCrossRefGoogle Scholar
  11. 11.
    Blichert-Toft M, Rose C, Anderson JA et al (1992) Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. Danish Breast Cancer Cooperative Group. J Natl Cancer Inst Monogr 11:19–25Google Scholar
  12. 12.
    Arriagada R, Le MG, Rochard F et al (1996) Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol 14(5):1558–1564PubMedGoogle Scholar
  13. 13.
    Lichter AS, Lippman ME, Danforth DN Jr et al (1992) Mastectomy versus breast-conserving therapy in the treatment of stage I and II carcinoma of the breast: a randomized trial at the National Cancer Institute. J Clin Oncol 10(6):976–983PubMedGoogle Scholar
  14. 14.
    Jacobson JA, Danforth DN, Cowan KH et al (1995) Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 332(14):907–911PubMedCrossRefGoogle Scholar
  15. 15.
    Van Dongen JA, Bartelink H, Fentiman IS et al (1992) Randomized clinical trial to assess the value of breast-conserving therapy in stage I and II breast cancer, EORTC 10801 trial. J Natl Cancer Inst Monogr 11:15–18Google Scholar
  16. 16.
    Bijker N, Meijnen P, Peterse JL et al (2006) Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in-situ: ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853—a study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. J Clin Oncol 24(21):3381–3387PubMedCrossRefGoogle Scholar
  17. 17.
    Chuba PJ, Simon MS (1997) Trends in primary surgical and radiation therapy for localized breast cancer in the Detroit metropolitan area 1973–1992. Int J Radiat Oncol Biol Phys 38:103–107PubMedGoogle Scholar
  18. 18.
    Polednak AP (1996) Trends in breast-conserving surgery in Connecticut: no effect of negative publicity. Conn Med 60:527–530PubMedGoogle Scholar
  19. 19.
    Morris CR, Cohen R, Schlag R et al (2000) Increasing trends in the use of breast-conserving surgery in California. Am J Public Health 90:281–284PubMedGoogle Scholar
  20. 20.
    Schwartz GF, Veronesi U, Clough KB et al (2006) Consensus conference on breast conservation. J Am Coll Surg 203(2):198–207PubMedCrossRefGoogle Scholar
  21. 21.
    Fung KW, Lau Y, Fielding R et al (2001) The impact of mastectomy, breast-conserving treatment and immediate breast reconstruction on the quality of life of Chinese women. ANZ J Surg 71:202–206PubMedCrossRefGoogle Scholar
  22. 22.
    Gelber RP, McCarthy EP, Davis JW et al (2006) Ethnic disparities in breast cancer management among Asian Americans and Pacific Islanders. Ann Surg Oncol 13(7):977–984PubMedCrossRefGoogle Scholar
  23. 23.
    Wolberg WH, Tanner MA, Romsaas EP et al (1987) Factors influencing options in primary breast cancer treatment. J Clin Oncol 5:68–74PubMedGoogle Scholar
  24. 24.
    Morris J, Ingham R (1988) Choice of surgery for early breast cancer: psychosocial considerations. Soc Sci Med 27:1257–1262PubMedCrossRefGoogle Scholar
  25. 25.
    Ward S, Heidrich S, Wolberg W (1989) Factors women take into account when deciding upon type of surgery for breast cancer. Cancer Nurs 12:344–351PubMedCrossRefGoogle Scholar
  26. 26.
    Stanton AL, Estes MA, Estes NC et al (1998) Treatment decision making and adjustment to breast cancer: a longitudinal study. J Consult Clin Psychol 66:313–322PubMedCrossRefGoogle Scholar
  27. 27.
    Mastaglia B, Kristjanson LJ (2001) Factors influencing women’s decisions for choice of surgery for stage I and stage II breast cancer in Western Australia. J Adv Nurs 35:836–847PubMedCrossRefGoogle Scholar
  28. 28.
    Lam WWT, Fielding R, Ho EYY et al (2005) Surgeon’s recommendation, perceived operative efficacy and age dictate treatment choice by Chinese women facing breast cancer surgery. Psycho-Oncol 24:585–593Google Scholar

Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  1. 1.Department of SurgeryThe University of Hong KongHong KongHong Kong

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