Annals of Surgical Oncology

, Volume 22, Issue 2, pp 383–391 | Cite as

‘Taking Control of Cancer’: Understanding Women’s Choice for Mastectomy

  • Andrea M. CovelliEmail author
  • Nancy N. Baxter
  • Margaret I. Fitch ( MScN, PhD)
  • David R. McCready
  • Frances C. Wright
Breast Oncology



Rates of both unilateral (UM) and contralateral prophylactic mastectomy (CPM) for unilateral early-stage breast cancer (ESBC) have been increasing since 2003. Recent studies suggest that this increase may be due to women choosing UM and CPM because of fear. We conducted an in-depth qualitative study to identify those factors influencing a woman’s choice for more extensive surgery.


Semi-structured interviews were conducted with breast cancer patients to examine the experiences, decision making, and choice of UM ± CPM for the treatment of ESBC. Purposive sampling identified suitable candidates for breast-conserving therapy (BCT) who underwent UM ± CPM. Interviews were guided by grounded theory methodology, and constant comparative analysis identified key concepts and themes.


Data saturation was achieved after 29 interviews. ‘Taking control of cancer’ was the dominant theme. Fear of breast cancer was expressed at diagnosis and remained throughout decision making. Personal experiences of family or friends ‘living with cancer’ were the most influential source of information during the decision-making process. Fear translated into an overestimated risk of recurrence, contralateral breast cancer (CBC), and death. Despite surgeons discussing equivalent survival with BCT, UM ± CPM patients believed that by choosing UM ± CPM they would eliminate recurrence, CBC and live longer. By choosing more extensive surgery, women were actively trying to control cancer outcomes as more surgery was believed to offer greater survival.


Women seek UM and CPM to take control of cancer and manage their fear. It is important for surgeons to understand how personal experiences shape women’s choice for UM ± CPM to facilitate informed decision making.


National Comprehensive Cancer Network National Comprehensive Cancer Network Contralateral Breast Cancer Contralateral Prophylactic Mastectomy Experiential Knowledge 
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.



With sincere thanks to Dr. M. Aarts, Dr. N. Down, Dr. R. George, and Dr. T. Gillis for their assistance in recruiting study participants. The authors would also like to thank all of the patient participants who offered their time and shared their experiences.


Dr. Covelli received a research fellowship from the Canadian Breast Cancer Foundation – Roche Physician Fellowship Program, and 1 year of salary support from the Clinical Investigator Program – Ontario Ministry of Health salary support program. She also received a travel grant to present work related to this research from the Canadian Institute of Health Research, as well as a Novartis Oncology Young Clinical Investigators Award (NOYCIA) and an ASCO Merit Award for work presented related to this research. The Surgeon Scientist Training Program provided indirect financial support to Dr. Covelli through programs delivered to surgeon scientists in training at the Department of Surgery, University of Toronto. Dr. Baxter holds the Cancer Care Ontario Health Services Research Chair. Dr. McCready receives research support from the Gattuso Chair in Breast Surgical Oncology at Princess Margaret Hospital.


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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Andrea M. Covelli
    • 1
    • 2
    • 3
    • 4
    Email author
  • Nancy N. Baxter
    • 1
    • 2
    • 3
  • Margaret I. Fitch ( MScN, PhD)
    • 2
    • 4
    • 5
  • David R. McCready
    • 1
    • 6
  • Frances C. Wright
    • 1
    • 2
    • 4
    • 7
  1. 1.Division of General SurgerySunnybrook Health Sciences CentreTorontoCanada
  2. 2.Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  3. 3.Department of Surgery and Li Ka Shing Knowledge InstituteSt Michael’s HospitalTorontoCanada
  4. 4.Odette Cancer Centre & Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoCanada
  5. 5.Bloomberg Faculty of NursingUniversity of TorontoTorontoCanada
  6. 6.Department of Surgical OncologyPrincess Margaret HospitalTorontoCanada
  7. 7.Department of Surgery & Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoCanada

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