Factors influencing a woman's choice to undergo breast conserving surgery versus modified radical mastectomy

BACKGROUND: The use of breast-conserving surgery (BCS) rather than modified radical mastectomy (MRM) for the treatment of breast carcinoma is an optio n for the majority of women (75%) with early stage breast cancer, but only 20% to 50% choose to undergo this procedure nationwide. The objective of th is study was to identify factors influencing a woman's choice between BCS a nd MRM, and specifically, the surgeon's influence on this choice. METHODS: A total of 134 women eligible for BCS were sent a survey. Data obt ained included demographics, influential factors in treatment choice, and s atisfaction with preoperative discussion and postoperative results. RESULTS: Ninety-six women completed the questionnaire. Mean patient age was 62 years. Most women surveyed felt their treatment options were satisfacto rily explained to them. BCS, MRM with reconstruction (MRM-R), and MRM witho ut reconstruction (MRM-NR) were performed in 45%, 15%, and 40% of patients, respectively, Overall, the most influential factor was the fear of cancer. Women choosing BCS indicated that the surgeon, cosmetic result, and psycho logical aspects were more influential in their decision than in women under going MRM-NR (P < 0.02). Fear of cancer was the most important factor affec ting the choice to undergo MRM-NR. In comparing MRM-R with MRM-NR, there wa s a similar fear of cancer; however, MRM-R had much greater concern with co smesis (P = 0.0002). CONCLUSIONS: The surgeon's input is important in a woman's choice to underg o BCS or MRM-R. However, it appears that if a woman wants to have MRM-NR, e ven when she is a candidate for BCS, the surgeon's input is overshadowed by the patient's fear of cancer. (C) 2001 by Excerpta Medica, Inc.