12P - Non-clinical factors influencing patient’s choice of mastectomy over breast conservation among Indian women with breast cancer

Background

Despite enough evidence supporting equal outcomes of Breast Conservation Therapy (BCT) and Modified Radical Mastectomy (MRM) in early breast, rates of mastectomy are still high in most of the regions of India barring few metro cities. Other than clinical parameters and availability of resources, several other sociodemographic factors and personal beliefs play a very vital role in decision making about type of surgery by Indian patients. This study aimed to investigate the factors which influenced the surgical choice in patients eligible for BCS.

Methods

Of 316 women who underwent surgery for Ca Breast in our department between Jan 2020 -Dec 2021, 119 were found to be eligible for BCS. A questionnaire containing details of various sociodemographic factors, individual beliefs and role of others in decision making was filled by patients. Univariate analysis was employed to determine the factors associated with the different surgical choices.

Results

Among 119 patients eligible for BCS; 12 patients were excluded for lack of consent or contact. Of 107 patients, 25 chose BCS and 82 chose MRM. On analysis of various socio-demographic factors, education above primary school, higher income, and urban residence was found to be significantly associated (P<0.02, P<0.03, P<0.02 respectively) with choice of BCS. Patients who received NACT or had family history of any malignancy were more inclined towards MRM, though the difference did not reach statistical significance. Among patients who chose MRM, about 2/3 feared about cancer recurrence or possibility of tumour being left behind with more conservative surgery while only 5% took this decision to avoid radiotherapy. Patient’s desire to hide their disease and surgery status as well as surgeons reassurance of equivalent survival were the driving factors among patients who chose BCS.

Conclusions

Decision making for type of surgery among breast cancer patients is complicated & governed by fears, social pressures, financial concerns & cosmetic expectations, which are slightly different among Indian women as compared to the western world. A better understanding of these may help increase the rate of BCS in rural and suburban population of India.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.