Factors Influencing Surgical Choices in Women with Breast Cancer
Valerie L. Staradub, MD, Yi-Ching Haleh, MS, Jennifer Clauson BS, Alexander Langerman, BA, Alfred W. Rademaker, Ph.D., Monica Morrow, MD

In the absence of medical contraindications, survival after breast conservation therapy (BCT), mastectomy (M), and M with immediate reconstruction (MIR) is equal. Between 1995 and 1998, 587 women with DCIS or early breast cancer with no contraindications to BCT or MIR were seen. Of this group, 85.2% chose BCT, 9.2% M, and 5.6% MIR. We examined demographic factors to see if they differed among groups using Fisher's exact test.

Marital status and employment approached significance (p=0.06), but family history of cancer was not a predictor of treatment choice. Women undergoing M alone were older and more likely to have stage II carcinoma than those undergoing BCT. Patients undergoing M or MIR were more likely to have had a prior breast biopsy than those choosing BCT. These findings suggest a need for patient education strategies that emphasize the lack of influence of age and prior breast biopsy on the use of BCT. Differences in demographic variables may reflect true variations in patient preference among groups, emphasizing the need to address the spectrum of treatment options with patients.

To identify demographic factors that influence surgical choices made by women eligible for breast conserving therapy (BCT).

• 587 consecutive women diagnosed between 1/95 and 12/98.
  
  
• Clinically stage I or II invasive breast cancer (n=479) or DCIS (n=108).
  
  
• Clinically eligible for BCT, mastectomy (M), or mastectomy with immediate recon struction (MIR).
  
  
• Patients viewed an informational video prior to an in-depth surgical consult. Cases were reviewed by our multi-disciplinary breast cancer team.

• Women undergoing mastectomy alone were older and more likely to have stage II breast cancer than those undergoing BCT.
  
  
• Single women and those employed outside the home were more likely to choose BCT (p=0.06), but family history of cancer was not a predictor of treatment choice.
  
  
• Patients undergoing M or MIR were more likely to have had a prior breast biopsy than those choosing BCT.

• Patient education strategies need to emphasize the lack of influence of age and prior breast biopsy on the use of BCT.
  
  
• Differences in demographic variables may reflect true variations in patient preference among groups, emphasizing the importance of discussing surgical options with each patient.

*p<0.05 vs. BCT

#p<0.05 MIR vs. M

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