Surgeon's recommendation, perceived operative efficacy and age dictate treatment choice by Chinese women facing breast cancer surgery.
OBJECTIVE
to identify factors influencing Chinese women's choices between breast-conserving therapy (BCT), mastectomy (MRM) or MRM followed by breast reconstruction (MRM+R).


METHODS
of 405/443 Hong Kong Chinese women receiving surgery for early breast cancer who were interviewed one week post-surgery about their pre-surgical consultation, available treatment alternatives, whether their surgeons had indicated a surgical preference, perceived efficacy of the surgical options and considerations influencing their treatment decisions (TDM), 198 (49%) reported they were offered a choice of surgery.


RESULTS
among women offered a choice of surgery, BCT was chosen by 34/43 (79%) of women whose surgeons recommended BCT but by only 34/96 (37%) of women whose surgeons expressed no treatment recommendation. Multivariate adjustment showed women choosing MRM were influenced more by avoiding both cancer recurrence (p = 0.003) and further treatment (p = 0.009) when choosing surgical option than women choosing BCT. In contrast, women choosing MRM+R and BCT, placed more emphasis on appearance (p < 0.001) and body image (p < 0.001) concerns as influencing treatment choice than did women who chose MRM.


CONCLUSIONS
survival concerns rather than physical appearance, age and lack of recommendation push Chinese women to choose MRM as BCT is, incorrectly often seen as less efficacious. Recommending BCT increases BCT choice.
Lam
Wendy W T
WW
Department of Nursing studies, University of Hong Kong, People's Republic of China. wwtlam@hkucc.hku.hk
Fielding
Richard
R
Ho
Ella Y Y
EY
Chan
Miranda
M
Or
Amy
A
D000328:Adult; D000368:Aged; D001828:Body Image; D001943:Breast Neoplasms / Q000208:ethnology* / Q000523:psychology / Q000601:surgery*; D003466:Cultural Characteristics; D003657:Decision Making; D005260:Female; D006723:Hong Kong / Q000208:ethnology; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D019651:Plastic Surgery Procedures; D013534:Survival; D016896:Treatment Outcome