Surgeon's recommendation, perceived operative efficacy and age dictate treatment choice by Chinese women facing breast cancer surgery

Abstract

Purpose: To identify factors influencing Chinese women's choices between breast-conserving therapy (BCT), mastectomy (MRM) or MRM followed by breast reconstruction (MRM+R). Methods: Of 405/443 Hong Kong Chinese women receiving surgery for early breast cancer who were interviewed one week post-surgery about their pre-surgical consultation, available treatment alternatives, whether their surgeons had indicated a surgical preference, perceived efficacy of the surgical options and considerations influencing their treatment decisions (TDM), 198 (49%) reported they were offered a choice of surgery. Results: Among women offered a choice of surgery, BCT was chosen by 34/43 (79%) of women whose surgeons recommended BCT but by only 34/96 (37%) of women whose surgeons expressed no treatment recommendation. Multivariate adjustment showed women choosing MRM were influenced more by avoiding both cancer recurrence (p = 0.003) and further treatment (p = 0.009) when choosing surgical option than women choosing BCT. In contrast, women choosing MRM + R and BCT, placed more emphasis on appearance (p < 0.001) and body image (p<0.001) concerns as influencing treatment choice than did women who chose MRM. Conclusion: Survival concerns rather than physical appearance, age and lack of recommendation push Chinese women to choose MRM as BCT is, incorrectly often seen as less efficacious. Recommending BCT increases BCT choice. Copyright © 2004 John Wiley & Sons, Ltd.