title: Factors associated with patients in the Scottish Highlands who chose mastectomy when suitable for breast conservation.
abstract: BACKGROUND
  Despite being suitable for breast conservation surgery (BCS) a proportion of women choose mastectomy. This study aimed to assess the pre-operative pathological and geographic factors associated with choosing mastectomy rather than BCS in a single centre that serves a large geographical area encompassing urban, rural and remote island populations.
  
  
  METHODS
  A retrospective analysis of all patients suitable for BCS between January 2011 and December 2013 was undertaken. Pre-operative pathological features were compared using the Pearson chi squared test as was distance to the treatment centre from the patient's home. A questionnaire was sent to all those who chose mastectomy to identify the factors that influenced their decision.
  
  
  RESULTS
  A total of 446 patients suitable for BCS were identified of which 46 (11%) chose to undergo mastectomy. Patients choosing mastectomy were more likely to present symptomatically (P=0.009), have tumours larger than 20 mm at diagnostic imaging (P=0.001) and have positive axillary staging (P=0.004). Patients choosing mastectomy were more likely to live remotely (P=0.051). Those patients who chose mastectomy felt this gave a better long-term outcome (18 patients, 44%) and peace of mind (14 patients, 34%).
  
  
  CONCLUSIONS
  Adverse pre-operative pathological features were associated with patients choosing mastectomy rather than BCS. There was a trend for patients who chose mastectomy to live remotely from the treatment centre. Patients choosing mastectomy most commonly cited a better long-term outcome and peace of mind as the reason behind their decision. Understanding what influences a patient's surgical choice will allow clinicians and patients to engage in a fully informed pre-operative decision making process.
authors: The Highland Breast Centre, Raigmore Hospital, Inverness, UK ;
authors: Rosalyn
authors: R
authors: Shearer
authors: The Highland Breast Centre, Raigmore Hospital, Inverness, UK ;
authors: Majid
authors: M
authors: Rashid
authors: The University of Stirling, The Centre for Health Sciences, Inverness, UK.
authors: Gill
authors: G
authors: Hubbard
authors: The Highland Breast Centre, Raigmore Hospital, Inverness, UK ;
authors: Nick
authors: N
authors: Abbott
authors: The Highland Breast Centre, Raigmore Hospital, Inverness, UK ;
authors: Ian
authors: I
authors: Daltrey
authors: The Highland Breast Centre, Raigmore Hospital, Inverness, UK ;
authors: Russell
authors: R
authors: Mullen
keywords: Breast cancer; breast-conserving surgery; choice behaviour; mastectomy