title: Which eligible breast conservation patients choose mastectomy in the setting of newly diagnosed breast cancer?
abstract: OBJECTIVE
  Breast conserving therapy (BCT) and mastectomy offer equivalent survival for women with newly diagnosed breast cancer (BrCa). Despite this, many women eligible for BCT elect mastectomy. Herein, we identify factors associated with choosing ipsilateral mastectomy instead of BCT when mastectomy is not required.
  
  
  METHODS
  Between July 2007 and June 2010, 520 women with BrCa were treated by a single surgeon who prospectively documented patient eligibility for BCT. For patients who did not require mastectomy (n=392), we evaluated associations between treatment choice and potential predictors using odds ratios (ORs) obtained from multivariable logistic regression models. P values≤0.0029 were significant after correction for multiple testing.
  
  
  RESULTS
  Of 392 women eligible for BCT, 106 (27%) chose mastectomy and 286 (73%) chose BCT. Multivariate analysis found an increased likelihood of electing mastectomy over BCT for patients with no comorbidities (OR 5.4; P<0.001) and those with previous mastectomy (OR 23.2; P<0.001). MRI and biopsy findings were associated with treatment choice because patients who had a second-site biopsy positive for cancer in the same quadrant as the index tumor were more likely to elect mastectomy compared with patients with no additional MRI abnormalities (OR 4.3; P=0.0027). No association existed on multivariate analysis between choice of mastectomy and patient age, family history, or tumor stage.
  
  
  CONCLUSIONS
  One in four eligible BCT patients chooses mastectomy. Factors independently associated with choosing mastectomy over BCT include findings of second-site biopsy, previous mastectomy, and absence of comorbidities but not primary tumor characteristics. Further study into a patient’s choice for mastectomy is warranted.
authors: Department of General Surgery, Mayo Clinic Florida, Jacksonville, Florida, USA.
authors: Cameron D
authors: CD
authors: Adkisson
authors: Sanjay P
authors: SP
authors: Bagaria
authors: Alexander S
authors: AS
authors: Parker
authors: Jillian M
authors: JM
authors: Bray
authors: Tammeza
authors: T
authors: Gibson
authors: Colleen S
authors: CS
authors: Thomas
authors: Michael G
authors: MG
authors: Heckman
authors: Sarah A
authors: SA
authors: McLaughlin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001940:Breast / Q000473:pathology / Q000601:surgery; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000601:surgery; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000601:surgery; D002755:Choice Behavior; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004608:Eligibility Determination; D005260:Female; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008408:Mastectomy / Q000401:mortality / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000401:mortality / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D011446:Prospective Studies; D011859:Radiography; D012086:Reoperation