Breast cancer has surfaced as the most common cancer in Indian females, with about a third being operable. Despite equivalent results of breast conserving surgery (BCS) + radiotherapy in early breast cancer as compared to mastectomy, it has not been widely adopted yet. Low rates of BCS, in a developing country is multifactorial. Lack of awareness of both patient and surgeon, limited availability of radiation expertise are a few factors. A study was undertaken to evaluate the factors responsible for decision making regarding the type of surgery in early breast cancers. The main objective of this study was to assess patient perceptions about their involvement in the decision making regarding surgical treatment.
128 early breast cancer patients who had undergone mastectomy or BCS from Jan 2014 to June 2015, were questioned about their involvement in surgical decision-making at our institution. Patients were interviewed about their literacy, socioeconomic status, insurance coverage, fear of tumour recurrence, surgical decision influencing factors in terms of independent decision, spouse, surgeon, patient + spouse or combined decision. Post surgery psychological status was also assessed.
Out of the 128 patients, 33% (44) had BCS and (84) 67% had MRM. BCS group had higher education level (70% graduates) as opposed to MRM group (21% graduates). There was higher proportion of younger women in the BCS group. Insurance coverage did not seem to influence the surgical decision. As perceived by the patients, surgeon seemed to play a major role in making MRM decision (55%) as compared to BCS (9%). BCS group revealed more patient involvement (30%) in decision making as compared to 2% in MRM group. Fear of tumour recurrence (95%) played a major role in MRM decision. Psychological evaluation revealed much higher rates of post mastectomy depression (90%) as opposed to BCS group (20%).
Overtreatment of early Breast cancer patients with MRM and lack of patient involvement in treatment decision making has raised concerns. Decision-making quality can be improved by increasing patients' knowledge about treatments' risks and benefits and by optimizing their involvement. The trend of lower BCS rates was comparable with the other developing countries.
Clinical trial identification
All authors have declared no conflicts of interest.