- Volume 15 Issue 7
DOI QR Code
Determinants of Choice of Surgery in Asian Patients with Early Breast Cancer in A Middle Income Country
- Teh, Yew-Ching (Breast Surgery Unit, Department of Surgery, University of Malaya Medical Centre) ;
- Shaari, Nor Elina Noor (Discipline of General Surgery, Surgical Cluster, Faculty of Medicine,University Technology MARA) ;
- Taib, Nur Aishah (Breast Surgery Unit, Department of Surgery, University of Malaya Medical Centre) ;
- Ng, Char-Hong (Breast Surgery Unit, Department of Surgery, University of Malaya Medical Centre) ;
- See, Mee-Hoong (Breast Surgery Unit, Department of Surgery, University of Malaya Medical Centre) ;
- Tan, Gie-Hooi (Breast Surgery Unit, Department of Surgery, University of Malaya Medical Centre) ;
- Jamaris, Suniza (Breast Surgery Unit, Department of Surgery, University of Malaya Medical Centre) ;
- Yip, Cheng-Har (Breast Surgery Unit, Department of Surgery, University of Malaya Medical Centre)
- Published : 2014.04.01
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 tumour and patient characteristics. Objective: This study aimed to assess the determinants of surgery choice in Asian patients with early breast cancer in a middle-income country. Materials and Methods: 184 patients with early breast cancer treated between Jan 2008 and Dec 2010 were recruited to complete a questionnaire. Chi-square test was used to analyze the association between surgery choice and demographic and tumour factors, surgeon recommendation, family member and partner opinions, fear of recurrence, avoidance of second surgery, fear of disfigurement, interference with sex life, fear of radiation and loss of femininity. Results: 85 (46%) had BCS while 99 (54%) had mastectomy. Age >60, Chinese ethnicity, lower education level, and larger tumour size were significantly associated with mastectomy. Surgeon recommendation was important in surgery choice. Although both groups did not place much importance on interference with sex life, 14.1% of the BCS group felt it was very important compared to 5.1% in the mastectomy group and this was statistically significant. There was no statistical difference between the two groups in terms of the other factors. When analyzed by ethnicity, significantly more Malay and Indian women considered partner and family member opinions very important and were more concerned about loss of femininity compared to Chinese women. There were no statistical differences between the three ethnic groups in terms of the other factors. Conclusions: When counseling on surgical options, the surgeon has to take into account the ethnicity, social background and education level, age and reliance on partner and family 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.
- Taib NA, Akmal M, Mohamed I, et al (2011). Improvement in survival of breast cancer patients - trends over two time periods in a single institution in an Asia Pacific country, Malaysia. Asian Pac J Cancer Prev, 12, 345-9.
- Yip CH, Taib NA, Mohamed I (2006). Epidemiology of breast cancer in Malaysia. Asian Pac J Cancer Prev, 7, 369-74.
- Mastaglia B, Kristjanson LJ (2001). Factors influencing women's decisions for choice of surgery for stage i and stage ii breast cancer in Western Australia. J Adv Nurs, 35, 836-47. https://doi.org/10.1046/j.1365-2648.2001.01921.x
- Mohd Taib NA, Yip CH, Mohamed I (2008). Survival analysis of malaysian women with breast cancer: results from the university of malaya medical centre. Asian Pac J Cancer Prev, 9, 197-202.
- Morrow M, White J, Moughan J, et al (2001). Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma. J Clin Oncol, 19, 2254-62. https://doi.org/10.1200/JCO.2001.19.8.2254
- Roder D, Zorbas H, Kollias J, et al (2013). Factors predictive of treatment by Australian breast surgeons of invasive female breast cancer by mastectomy rather than breast conserving surgery. Asian Pac J Cancer Prev, 14, 539-45. https://doi.org/10.7314/APJCP.2013.14.1.539
- Taib NA, Yip CH, Low WY. et al (2013). A grounded explanation of why women present with advanced breast cancer. World J Surg, [Epub ahead of print].
- Tam Ashing K, Padilla G, Tejero J, et al (2003). Understanding the breast cancer experience of Asian American women. Psychooncology, 12, 38-58. https://doi.org/10.1002/pon.632
- Veronesi U, Cascinelli N, Mariani L, et al (2002). Twentyyear follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med, 347, 1227-32. https://doi.org/10.1056/NEJMoa020989
- Yang SH, Yang KH, Li YP, et al (2008). Breast conservation therapy for stage I or stage II breast cancer: a meta-analysis of randomized controlled trials. Ann Oncol, 19, 1039-44. https://doi.org/10.1093/annonc/mdm573
- Mac Bride MB, Neal L, Dilaveri CA, et al (2013). Factors associated with surgical decision making in women with early-stage breast cancer: a literature review. J Womens Health (Larchmt), 22, 236-242. https://doi.org/10.1089/jwh.2012.3969
- Lam WW, Fielding R, Ho EY, et al (2005). Surgeon's recommendation, perceived operative efficacy and age dictate treatment choice by Chinese women facing breast cancer surgery. Psychooncology, 14, 585-93. https://doi.org/10.1002/pon.877
- Lazovich D, Solomon CC, Thomas DB, et al (1999). Breast conservation therapy in the united states following the 1990 national institutes of health consensus development conference on the treatment of patients with early stage invasive breast carcinoma. Cancer, 86, 628-37. https://doi.org/10.1002/(SICI)1097-0142(19990815)86:4<628::AID-CNCR11>3.0.CO;2-L
- Lazovich DA, White E, Thomas DB, et al (1991). Underutilization of breast-conserving surgery and radiation therapy among women with stage I or II breast cancer. JAMA, 266, 3433-8. https://doi.org/10.1001/jama.1991.03470240055032
- Maly RC, Umezawa Y, Ratliff CT, et al (2006). Racial/ethnic group differences in treatment decision-making and treatment received among older breast carcinoma patients. Cancer, 106, 957-65. https://doi.org/10.1002/cncr.21680
- Abdullah A, Abdullah KL, Yip CH, et al (2013). The decisionmaking journey of Malaysian women with early breast cancer: a qualitative study. Asian Pac J Cancer Prev, 14, 7143-7. https://doi.org/10.7314/APJCP.2013.14.12.7143
- Albain KS, Green SR, Lichter AS, et al (1996). Influence of patient characteristics, socioeconomic factors, geography, and systemic risk on the use of breast-sparing treatment in women enrolled in adjuvant breast cancer studies: an analysis of two intergroup trials. J Clin Oncol, 14, 3009-17. https://doi.org/10.1200/JCO.19184.108.40.20609
- Fisher B, Anderson S, Bryant J, et al (2002). Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med, 347, 1233-41. https://doi.org/10.1056/NEJMoa022152
- Hawley ST, Griggs JJ, Hamilton AS, et al (2009). Decision involvement and receipt of mastectomy among racially and ethnically diverse breast cancer patients. J Natl Cancer Inst, 101, 1337-47. https://doi.org/10.1093/jnci/djp271
- Hiotis K, Ye W, Sposto R, et al (2005). Predictors of breast conservation therapy: size is not all that matters. Cancer, 103, 892-9. https://doi.org/10.1002/cncr.20853
- Kaufmann M, Morrow M, Von Minckwitz G, et al (2010). Locoregional treatment of primary breast cancer: consensus recommendations from an International Expert Panel. Cancer, 116, 1184-91. https://doi.org/10.1002/cncr.24874
- To Share or Not to Share: Malaysian Healthcare Professionals' Views on Localized Prostate Cancer Treatment Decision Making Roles vol.10, pp.11, 2015, https://doi.org/10.1371/journal.pone.0142812
- Understanding Women’s Choice of Mastectomy Versus Breast Conserving Therapy in Early-Stage Breast Cancer vol.11, pp.1179-5549, 2017, https://doi.org/10.1177/1179554917691266
- Opportunistic mammography screening provides effective detection rates in a limited resource healthcare system vol.15, pp.1, 2015, https://doi.org/10.1186/s12885-015-1419-2