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Conservation Surgery for Breast Cancer As the Preferred Choice: A Prospective Analysis

Walley J. Temple, Margaret L. Russell, Louise L. Parsons, Sylvia M. Huber, Charlotte A. Jones., Jane Bankes, Michael Eliasziw

From the Departments of Oncology and Surgery, Community Health Sciences and Surgery, Medicine and Community Health Sciences, and Community Health Sciences and Clinical Neurosciences, University of Calgary; and the Departments of Surgical Oncology and Seniors Health and Palliative Care, Calgary Health Region, Calgary, Alberta, Canada

Address reprint requests to Margaret L. Russell, MD, PhD, FRCPC, Department of Community Health Sciences, The University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta, Canada, T2N 4N1; e-mail: mlrussel{at}ucalgary.ca

PURPOSE: To describe the proportion of women who anticipate having breast-conserving surgery (BCS) versus modified radical mastectomy (MRM), the factors they considered when making treatment choices, the degree to which they perceived they had participated in and had control of the treatment decision, and to explore factors associated with type of planned surgery.

PATIENTS AND METHODS: Prospective cohort study conducted among patients attending a tertiary care hospital in Alberta, Canada from 1992 to 1995. Participants had a first diagnosis of localized unilateral breast cancer, and were, in the opinions of their surgeons, candidates for either BCS or MRM.

RESULTS: Of 157 participants, 71.3% anticipated having BCS and 28.7% anticipated MRM. Referents perceived to play an important role in decision making included self, doctor, and significant other. The two top-ranked items perceived to have influenced treatment choice were doctor's advice and possibility of complete cure. Most women (60%) participated in treatment choice to the degree that they preferred, but only 13.6% received their preferred amount of information. The type of planned surgery was predicted by surgeon, contribution of doctor to choice of treatment, importance of breasts to sexuality, self-efficacy, and concerns about cancer recurrence from a multivariable logistic regression model.

CONCLUSION: Both patient and surgeon factors are important predictors of type of planned surgery. There is a gap between women's preferences and actual experiences with regard to information provided and patient participation in treatment choices, with women’s desire for more information about their treatment being most prevalent.

Supported by the Canadian Breast Cancer Research Initiative. M.E. is supported by a Senior Health Scholar Award from the Alberta Heritage Foundation for Medical Research.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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