Predictors of surgery choices in women with early-stage breast cancer in China: a retrospective study

Abstract

Background The breast-conserving surgery and reconstruction rate in China is relatively low when compared with those in Western countries. Moreover, predictors of surgical choices for women with breast cancer in China have not yet been explored. This study aims to explore differences in the surgical choices of women with different demographic and clinical characteristics and the predictors that influence surgical choices of women with early-stage breast cancer. Methods This retrospective study included women with early-stage (0-II) breast cancer who underwent surgeries at one of two Xiamen University-affiliated hospitals between 2009 and 2017. Using medical records, eleven variables were collected: the woman's age, year of diagnosis, hospital, marital status, payment method, cancer stage, presence of positive axillary lymph node, histology, neoadjuvant chemotherapy, radiotherapy, and the type(s) of surgery they chose. Binary logistic regression was used to analyse predictors of surgical choice. Results A total of 1,787 cases were included in this study. Of the total number of women with breast cancer, 61.3% underwent mastectomy without breast reconstruction, 26.4% underwent mastectomy with breast reconstruction, and the remaining 12.2% chose breast-conserving surgery. Women with different demographic and clinical characteristics underwent different types of surgery. Cancer stage, neoadjuvant chemotherapy, radiotherapy, and the choice of hospital were found to be predictors of breast-conserving surgery. Meanwhile, age, year of diagnosis, payment method, neoadjuvant chemotherapy, and the choice of hospital were found to be predictors of reconstruction after mastectomy in women with early-stage breast cancer. Conclusions In China, surgical choices for women with breast cancer have diversified. Healthcare workers should understand the surgical preferences of women of different ages. For early detection of breast cancer, knowledge of breast self-examination and breast cancer screening should be provided. Adequate information about the safety of reconstruction and advocacy for medical insurance coverage of reconstruction should be offer. Breast surgeons need specialised training and standardising protocols towards different types of breast surgery. These actions will help women make better, well-informed decisions about their breast surgeries.

Decision‐making experiences related to mastectomy: A descriptive qualitative study

“…The medical expenditures related to breast cancer can amount to twice the women's income, which can impoverish Chinese women and their families (Liao et al, 2018;Liu et al, 2022). Besides, radiotherapy is an essential component of BCS to reduce the risk of local recurrence, which may add extra financial burdens to women (Huang et al, 2023). These financial factors may lead women to prefer mastectomy to BCS when considering treatment options.…”

Prognosis of breast-conserving surgery versus total mastectomy in young breast cancer patients based on SEER and Hebei Province cohort

“…We found that the prognosis of patients treated surgically at the Hebei Tumor Control O ce was the opposite of the prognosis of cases collected by SEER, with better OS in the BCS group than in the TM group (P < 0.05). The choice of surgical modality for breast cancer in China differs signi cantly from that in Western countries, and a study of 110 hospitals across China reported that only 22% of breast cancer patients chose breast-conserving surgery [25] , and the proportion of patients choosing breastconserving surgery in several other domestic studies was lower than 22% [26,27] , compared with 56.4%-64.5% in the United States [28] . Fewer young patients screened by the Hebei Tumor Control O ce underwent breast-conserving surgery, which is consistent with the above ndings, according to Sinnadurai [29] and Zhang [26] , who showed that the difference in surgery rates may be due to different cultural backgrounds, with patients believing that removal of the entire breast may reduce the risk of leaving residual lesions, and patients who are knowledgeable about breast-conserving surgery less than half, and a survey of husbands of domestic patients also showed that more than 80% disapproved of patients undergoing breast-conserving surgery [30] .…”

Quantifying vegetation change and driving mechanism analysis in Sichuan from 2000 to 2020

“…Geographical detectors can either test for spatial heterogeneity of a single variable or detect possible causal relationships between two variables by testing them (Song et al, 2020;Zhang et al, 2020). It consists of four main components: factor detection, interaction detection, risk zone detection and ecological detection (Wang et al, 2016;Wang et al, 2017;Huang et al, 2023). In this paper, the interaction detection tool and the Geodetector interaction detection tool were selected to analyse the influence of vegetation cover drivers in Sichuan Province.…”