Determinants of Choice of Surgery in Asian Patients with Early Breast Cancer in A Middle Income Country

Background: Breast-conserving surgery (BCS) plus radiotherapy is equivalent to modified radical mastectomy(MRM) in terms of outcome. However there is wide variation in mastectomy rates dependent both on tumourand patient characteristics.
Objective: This study aimed to assess the determinants of surgery choice in Asianpatients with early breast cancer in a middle-income country. Materials and
Methods: 184 patients with earlybreast cancer treated between Jan 2008 and Dec 2010 were recruited to complete a questionnaire. Chi-squaretest was used to analyze the association between surgery choice and demographic and tumour factors, surgeonrecommendation, family member and partner opinions, fear of recurrence, avoidance of second surgery, fearof disfigurement, interference with sex life, fear of radiation and loss of femininity.
Results: 85 (46%) had BCSwhile 99 (54%) had mastectomy. Age >60, Chinese ethnicity, lower education level, and larger tumour size weresignificantly associated with mastectomy. Surgeon recommendation was important in surgery choice. Althoughboth groups did not place much importance on interference with sex life, 14.1% of the BCS group felt it wasvery important compared to 5.1% in the mastectomy group and this was statistically significant. There was nostatistical difference between the two groups in terms of the other factors. When analyzed by ethnicity, significantlymore Malay and Indian women considered partner and family member opinions very important and were moreconcerned about loss of femininity compared to Chinese women. There were no statistical differences between thethree ethnic groups in terms of the other factors.
Conclusions: When counseling on surgical options, the surgeonhas to take into account the ethnicity, social background and education level, age and reliance on partner andfamily members. Decision-making is usually a collective effort rather than just between the patient and surgeon,and involving the whole family into the process early is important.