title: Patients' refusal of surgery strongly impairs breast cancer survival.
abstract: OBJECTIVE
  To compare patient and tumor characteristics and survival between women who refused and women who accepted surgery for breast cancer.
  
  
  BACKGROUND
  Surgery represents the central component of curative breast cancer treatment, but some women decide not to undergo surgery. Recent studies on the prognosis of non operated breast cancer are nonexistent.
  
  
  METHODS
  This study included all 5339 patients aged < 80 years with nonmetastatic breast cancer recorded at the Geneva Cancer Registry between 1975 and 2000. We consulted the clinical files of all nonoperated women to identify those who refused surgery. Patients who refused surgery were compared with those accepting surgery using logistic regression. The effect of refusal of surgery on breast cancer mortality was evaluated by Cox proportional hazards analysis.
  
  
  RESULTS
  Seventy patients (1.3%) refused surgery. These women were older, more frequently single, and had larger tumors. Overall, 37 (53%) women had no treatment, 25 (36%) hormone-therapy alone, and 8 (11%) other adjuvant treatments alone or in combination. Five-year specific breast cancer survival of women who refused surgery was lower than that of those who accepted (72%, 95% confidence interval, 60%-84% versus 87%, 95% confidence interval, 86%-88%, respectively). After accounting for other prognostic factors including tumor characteristics and stage, women who refused surgery had a 2.1-fold (95% confidence interval, 1.5-3.1) increased risk to die of breast cancer compared with operated women.
  
  
  CONCLUSIONS
  Women who refuse surgery for breast cancer have a strongly impaired survival. This information might help patients who are hesitant toward surgery make a better informed decision.
authors.affiliation: Geneva Cancer Registry, Institute for Social and Preventive Medicine, Geneva University, Switzerland.
authors.forename: Helena M
authors.initials: HM
authors.lastname: Verkooijen
authors.forename: Gérald M
authors.initials: GM
authors.lastname: Fioretta
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Rapiti
authors.forename: Hervé
authors.initials: H
authors.lastname: Bonnefoi
authors.forename: Georges
authors.initials: G
authors.lastname: Vlastos
authors.forename: John
authors.initials: J
authors.lastname: Kurtz
authors.forename: Peter
authors.initials: P
authors.lastname: Schaefer
authors.forename: André-Pascal
authors.initials: AP
authors.lastname: Sappino
authors.forename: Hyma
authors.initials: H
authors.lastname: Schubert
authors.forename: Christine
authors.initials: C
authors.lastname: Bouchardy
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality* / Q000601:surgery* / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D016312:Treatment Refusal