Breast cancer is the most common cancer in Indian females, about a third being operable. The reason for low rates of BCS in early breast cancer (EBC) is multifactorial inspite of results from SABCS 2015 which revealed better survival in BCS patients than in mastectomy group. India is a culturally rich, multilinguistic and diverse nation, with many communities which live in their respective social structures, contributing to low rates of BCS. Understanding these multidimensional psychosocial, and cultural factors are essential for providing comprehensive and appropriate cancer care. Our objective was to look at factors that influence the type of surgery in EBC in our diverse cultural and socioeconomic background and to improvise.
153 EBC pateints at Apollo hospitals from Jan 2014 to June 2015, were interviewed regarding various factors which influence the surgical decision. The questionnaire included literacy, economic status, single or joint family, rural or urban, deciding factor- patient preference, family and surgeon, psychological impact interms of anxiety or depression and fear of tumour recurrence.
Of the total 153 EBC patients, 36% (55) had BCS and rest (98) 64% had MRM. BCS group had more urban population (64 %) than in mastectomy group (56%). BCS group had higher education level (66% graduates) as opposed to patients undergoing MRM (23% graduates). Higher proportion of younger women was observed in the BCS (69%)group as opposed to mastectomy group (33%). Surgeon seemed to play a major role in making MRM decision (67%) as compared to BCS (11%) in contrast to western scenario where patient has a major role in decision making. BCS group had significant patient involvement (39%) in decision making as compared to 10% in MRM group. Fear of tumour recurrence (81% vs 38%) and post mastectomy depression (91% vs 58%) was higher in the mastectomy group as compared to BCS group.
Surgical decision in EBC patients is influenced by varying socio-demographic characteristics that results in disparities in cancer care and health outcomes. Health care providers need to be attentive to the varied socio- cultural factors. Optimizing patient involvement in the surgical decision making of EBC is the need of the hour.
Clinical trial identification
Legal entity responsible for the study
Apollo Hospitals Bangalore
All authors have declared no conflicts of interest.