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A Patient-Centered Approach to Understanding Influences in Decision-Making for Breast Cancer Surgery
*Jennifer D Hanson1, *Michael R Hart1, *Takamaru Ashikaga1, *Andrea Steely1, *Laurence E McCahill2, *Christine Vatovec1, Ted A James1
1University of Vermont College of Medicine, Burlington, VT;2Metro Health Surgical Oncology, Wyoming, MI

Background: Many women eligible for breast-conserving surgery (BCS) still choose total mastectomy (TM), and little is known about decision-making factors. This study investigated selection factors of TM over BCS, to understand influences in patient decision-making.
Methods: A matched case-control survey study of eligible patients from a four-year, prospective Breast Cancer Surgical Quality Database.  Participants included female patients with invasive carcinoma who, despite being eligible for BCS, elected TM.  Inclusion criteria consisted of women with no contraindication to BCS, tumor size <2cm, and absence of extensive microcalcifications. Patients with tumor recurrence, multicentric disease, and scleroderma/lupus were excluded.  Patients were administered a telephone survey to elicit factors affecting their TM decision.
Results: Of 670 patients treated for IDC/ILC between 2003 and 2007, 12 who underwent TM met criteria. These were matched with 27 who underwent BCS. All were subsequently interviewed. TM patients were more influenced than BCS patients by having breast reconstruction available. More patients choosing mastectomy disbelieved TM and BCS provided equal overall survival likelihood. Fewer patients choosing mastectomy identified their surgeon as the most influential information provider. No difference existed between groups regarding fear of recurrence, role in decision-making, or transportation issues.
Conclusions: Patients with small, invasive breast cancers choosing TM, despite BCS eligibility, were primarily influenced by breast reconstruction availability, persistent belief in TM and BCS survival outcomes differences, and influential information from sources other than their surgeon. Factors persisted despite treatment at a multidisciplinary center, providing accurate survival and recurrence information. Further assessment of patient perceptions of risk and greater awareness of decision-making factors is needed.


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