Factors Influencing the Choice of Mastectomy Over Breast Conservation Surgery in Early Breast Cancer: A Prospective Qualitative Exploration of Patient Perspectives From India

Background

Breast conservation surgery (BCS) has not been a widely adopted treatment in early breast cancer despite its oncological outcomes similar to mastectomy. In emerging economies, BCS rates are < 40% compared to > 70% in the West. Hence, this study was undertaken to describe factors influencing the underutilization of BCS.

Methods

A prospective longitudinal study was conducted between September 2019 and December 2021 on patients with biopsy-proven early breast cancer eligible for BCS. The choice of surgery (mastectomy vs. breast conservation) by patients was recorded at initial diagnosis and staging. A predesigned structured questionnaire was used to identify the factors associated with their choice of mastectomy. The patients received multiple counseling sessions by the operating surgeon(s), and the choice of surgery was recorded again. Factors associated with the choice of surgery were identified and evaluated by univariate or multivariate logistic regression.

Results

Out of 238 consecutive patients operated on in the study period, 84 met eligibility criteria and were recruited. At the time of initial diagnosis and staging, 13 (15.5%) patients wanted BCS. After multiple counseling sessions, finally, 75 (89.3%) opted for BCS; however, 9 (10.7%) still wanted mastectomy. The factors influencing the choice of mastectomy were fear of outcome (90% of patients), followed by family influence (35%), radiation-related factors (30%), personal factors (25%), and surgery-related factors (25%).

Conclusions

Systematic counseling by the treating team markedly improved breast conservation acceptance rates from 15.5% to 89.3%. Fear of outcome is the major factor influencing the choice of mastectomy over BCS in early breast cancer patients suitable for BCS.