title: Determinants of choice of surgery in Asian patients with early breast cancer in a middle income country.
abstract: 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.
  
  
  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.
authors.affiliation: Breast Surgery Unit, Department of Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia E-mail : ycteh11@gmail.com.
authors.forename: Yew-Ching
authors.initials: YC
authors.lastname: Teh
authors.forename: Nor Elina Noor
authors.initials: NE
authors.lastname: Shaari
authors.forename: Nur Aishah
authors.initials: NA
authors.lastname: Taib
authors.forename: Char-Hong
authors.initials: CH
authors.lastname: Ng
authors.forename: Mee-Hoong
authors.initials: MH
authors.lastname: See
authors.forename: Gie-Hooi
authors.initials: GH
authors.lastname: Tan
authors.forename: Suniza
authors.initials: S
authors.lastname: Jamaris
authors.forename: Cheng-Har
authors.initials: CH
authors.lastname: Yip
mesh_terms: D000328:Adult; D044466:Asian People; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D008296:Malaysia; D015411:Mastectomy, Modified Radical; D015412:Mastectomy, Segmental; D008875:Middle Aged; D010358:Patient Participation; D057240:Patient Preference; D011795:Surveys and Questionnaires