Understanding Women’s Choice of Mastectomy Versus Breast Conserving Therapy in Early-Stage Breast Cancer

Abstract

Objective:To identify factors that influence Saskatchewan women’s choice between breast conserving therapy (BCT) and mastectomy in early-stage breast cancer (ESBC) and to compare and contrast underlying reasons behind choice of BCT versus mastectomy.Methods:Interpretive description methods guided this practice-based qualitative study. Data were analyzed using thematic analysis and presented in thematic maps.Results:Women who chose mastectomy described 1 of the 3 main themes: worry about cancer recurrence, perceived consequences of BCT treatment, or breast-tumor size perception. In contrast, women chose BCT because of 3 different themes: mastectomy being too radical, surgeon influence, and feminine identity.Conclusions:Although individual reasons for choosing mastectomy versus BCT have been discussed in the literature before, different rationale underlying each choice has not been previously described. These results are novel in identifying interdependent subthemes and secondary reasons for each choice. This is important for increased understanding of factors influencing a complicated decision-making process.

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

“…Surgeon or system differences could account for some of the variation in the type of surgery chosen. The level of surgeon influence on women's surgery decisions is a significant factor in published studies . Patients treated publicly and those living in the most deprived socio‐economic quintile (9, 10) were less likely to receive BCS.…”

“…Factors influencing decision‐making include surgeon opinion, tumour size (and size relative to breast size) and location, access to RT, socio‐economic status and education level, ethnicity, co‐morbidity, use of preoperative magnetic resonance imaging, BReast CAncer gene (BRCA) status and family history . Fear of recurrent cancer is an important factor driving the uptake of mastectomy, which offers a perception of reduced risk and avoidance of repeat treatments or RT associated with BCS . In contrast, BCS is perceived as less radical, with a positive cosmetic outcome and body image .…”

“…Fear of recurrent cancer is an important factor driving the uptake of mastectomy, which offers a perception of reduced risk and avoidance of repeat treatments or RT associated with BCS . In contrast, BCS is perceived as less radical, with a positive cosmetic outcome and body image . From a surgical perspective, more women are becoming suitable for BCS with growing training and use of oncoplastic techniques, including reduction or volume replacement techniques.…”

Krūtų Rekonstrukcinių Operacijų Silikoniniais Implantais Komplikacijos. Klaipėdos Universitetinės Ligoninės Retrospektyvinė Duomenų Analizė

“…Nepaisant to, jog studijos įrodė krūtį išsaugančią operaciją ankstyvo krūties vėžio atveju esant tokią pat saugią kaip ir krūties pašalinimo operaciją, mastektomijų skaičius visame pasaulyje didėja [2]. Moterų, kurioms buvo galima atlikti krūtį tausojančias operacijas, vietoje jos pasirinkusių mastektomijas, skaičius išaugo nuo 34,3% (1998 m.) iki 37,8% (2011 m.).…”

“…Pasekmės, kurios dažniausiai neramina moteris, svarstančias rinktis konservatyvią krūties operaciją, yra pooperacinis spindulinis gydymas bei dažnos pakartotinės operacijos esant neradikaliam auglio pašali-nimui. Mastektomiją taipogi linkę rinktis moterys, kurių krūtys mažos, o navikas santykinai didelis dėl nepakankamo estetinio pooperacinio rezultato [2]. Mastektomijų skaičiaus augimui neabejotinai įtakos turi ir 1997 m. Krūties vėžio konsorciumo paskelbta rekomendacija atlikti profilaktines mastektomijas moterims, turinčioms nustatytas BRCA genų mutacijas [5].…”