Mastectomy Versus Breast-Conservation Therapy: An Examination of How Individual, Clinicopathologic, and Physician Factors Influence Decision-Making

Abstract

Background The choice of mastectomy compared with breast-conservation therapy (bct) in early-stage breast cancer (esbca) is a complicated decision-making process. Interprovincially, Canada’s mastectomy rates vary from 25% to 68%, with Saskatchewan reporting the nation’s second-highest mastectomy rate at 63%. The aim of our research was to better understand why women with esbca choose mastectomy rather than bct in Saskatchewan.Methods We created a survey based on a previously developed framework that organizes influencing factors into 3 constructs: clinicopathologic, physician, and individual belief factors.Results Treatment choice was found to be influenced by disease stage and multiple individual belief factors. Compared with their counterparts having stage i disease, women with stage ii disease were significantly more likely to undergo mastectomy [odds ratio (or): 7.48]. Patients rating “worry about cancer recurrence” and “total treatment time” as more influential in their choice were also more likely to undergo mastectomy (or: 3.4 and 1.8 respectively). Conversely, women rating “wanting to keep own breast tissue,” “tumour size,” and “surgeon’s opinion” as influential in their choice were more likely to undergo bct (or: 0.17, 0.66, and 0.69 respectively).Conclusions Our study demonstrates that treatment choices for Saskatchewan women with esbca are influenced primarily by disease stage and individual belief factors. Those findings suggest that women are making their treatment choices predominantly based on individual values and preferences. The use of rates of mastectomy and bct as indicators of quality of care might be misleading. Instead, a shift in attention toward patient-centred care might be more appropriate.

Screening is associated with lower mastectomy rates in eastern Switzerland beyond stage effects

“…Furthermore, the mammography screening programme in St.Gallen follows strict quality assurance guidelines and may preferentially refer patients to specialized breast centres. For women with early BC it has been shown, that surgeons with higher caseloads and in multidisciplinary settings, such as in breast centres, are associated with decreased mastectomy rates [ 10 ]. Specialized breast centres in Switzerland are certified and monitored by EUSOMA, a non-profit society that promotes evidence-based high quality care for breast cancer patients by multidisciplinary breast teams [ 2 , 7 ].…”

MRI-Derived Tumour-to-Breast Volume Is Associated with the Extent of Breast Surgery

“…Hypothesizing five TBVR classes, the two extremes (classes 1 and 5) would comprise TBVR values in which mastectomy and breast-conserving surgery are almost invariably performed. Classes 2 and 4 would represent an intermediateto-high probability of receiving each surgery, with limited discretional variations justified by recognized factors, such as a pre-existing high risk of recurrence (e.g., in BRCA positive patients) [33,34] or patient preferences [33], or by tumour-specific features such as multifocality [33,34], location in quadrants that are at higher risk for postoperative breast deformity [11], wide extension preventing the obtainment of an optimal margin width and increasing re-excision risks [35][36][37][38]. These factors would even more deeply interplay with TBVR in the middle class, 3, in which multidisciplinary evaluation would still be the main determinant of the surgical choices.…”

Screening is Associated with Lower Mastectomy Rates in Eastern Switzerland Beyond Stage Effects

“…Furthermore, the mammography screening programme in St.Gallen follows strict quality assurance guidelines and may preferentially refer patients to specialized breast centres. It has been shown, that surgeons with higher caseloads and in multidisciplinary settings, such as in breast centres, are associated with decreased mastectomy rates for women with early BC (Gu et al 2019). Specialized breast centres in Switzerland are certi ed and monitored by EUSOMA, a non-pro t society that promotes evidence-based high quality care for breast cancer patients by multidisciplinary breast teams (EUSOMA 2020).…”