Decision-Making in the Surgical Treatment of Breast Cancer: Factors Influencing Women’s Choices for Mastectomy and Breast Conserving Surgery

Abstract

One of the most difficult decisions a woman can be faced with when choosing breast cancer treatment is whether or not to undergo breast conserving surgery or mastectomy. The factors that influence these treatment decisions are complex and involve issues regarding access to health care, concerns for cancer recurrence, and the impact of surgery on body image and sexuality. Understanding these factors will help practitioners to improve patient education and to better guide patients through this decision-making process. Although significant scientific and societal advances have been made in improving women’s choices for the breast cancer treatment, there are still deficits in the decision-making processes surrounding the surgical treatment of breast cancer. Further research is needed to define optimal patient education and shared decision-making practices in this area.

Squamous cell carcinoma of the breast in the United States: incidence, demographics, tumor characteristics, and survival

“…The role of squamous histology, if any, in selection of mastectomy in these patients needs to be evaluated in future studies. Furthermore, our study did not evaluate several factors associated with increased rates of mastectomy including the use of MRI, genetic testing results, socioeconomic factors, and several other patient characteristics [29,30].…”

Socioeconomic and demographic disparities in breast cancer stage at presentation and survival: A Swiss population‐based study

“…35 Comorbidities might be associated with less complete diagnostic assessment including biopsy for staging, 32,33 limited treatment options and a decreased likelihood to receive treatment with curative intent. 47 Further, SEP might influence patients treatment choice 48 and/or adherence to treatment. 49 However, studies in the canton of Geneva suggest that observed survival inequalities after BC are-at least partlycaused by differences in care management depending on SEP. 14,15 Unfortunately, information on comorbidities were not available for this study.…”

Surgical treatment of early stage breast cancer in the Auckland and Waikato regions of New Zealand

“…These recommendations led to a steady increase in the uptake of BCS . More recently, however, rates of mastectomy have been seen to increase in the USA, even in women with breast cancer that is suitable for BCS …”

“…A small number of women are diagnosed with cancer in both breasts and undergo bilateral surgery – usually bilateral mastectomy. In some cases, women with unilateral disease choose bilateral mastectomy to prevent cancer in the other breast, despite no clinical evidence to support any further survival benefit . In addition, an increasing option for women choosing mastectomy is to have immediate breast reconstruction, using either autologous techniques (deep inferior epigastric perforator (DIEP) artery flaps, transverse rectus abdominis myocutaneous (TRAM) flaps and latissimus dorsi (LD) flaps) or implant‐based reconstruction…”