Abstract P4-13-07: Determinants in decision-making process of breast reconstruction in women over 65 years old
Authors: Quemener J , Wallet J , Boulanger L , Hannebicque K , Giard S , Chauvet MP , Regis C 
Published: February 2018

Background: Breast cancer is the most common cancer among European women with 54,000 new cases in France in 2015. Nearly 47% of these cancers are diagnosed in women aged 65 and over. Mastectomy is still needed in 30% of cases, resulting in significant physical and psychological consequences. Breast reconstruction (BR) can reduce the effects of surgical treatment and improve quality of life. However, less than 20% of women choose BR in France. This number drops to 6% for patients over 65 years old. The objective of the study was to find the factors influencing the decision-making process for attempting breast reconstruction in women who are over 65.

Methods: We included retrospectively all patients over 65 years old who had an immediate or delayed breast reconstruction in our Cancer Center from January 2006 to July 2016. We set up a control group matching them with patients treated by mastectomy during the same period who did not choose BR. The matched-pair criteria were age, TNM stage and performans status, obtained from multidisciplinary consultation meeting database. We mailed to all patients a specially-designed questionnaire inspired by the BREAST-Q aimed at assessing the medical information that was delivered to them about BR and the reasons to choose or not choose reconstruction. The qualitative and quantitative results were analyzed. The two groups were compared using Chi-square, Fisher's exact, Mann-Whitney, and Student t test.

Results: Among 134 patients, 103 (77%) completed the questionnaire. Dedicated information on BR before the mastectomy was provided more frequently to patients who had BR (91.7% vs 66.7% p=0.008). Forty-one percent of patients sought out sources of information other than their surgeon (other physicians, friends, other patients, the internet – no significant differences between the two groups, p=0.1). The three most important persons influencing the decision-making process were first the patient's surgeon, second the patient's husband, and third her general practitioner (GP). These people were more often in favor of reconstruction in the BR group than in the mastectomy group (respectively, 94.5% vs 22.9% p&lt;0.001; 65.4% vs 7.1 % p&lt;0.001; and 64.2% vs 19.4%, p&lt;0.001). Women judged that their age was an obstacle to reconstruction at the rate of 66.7% for the mastectomy group and at the rate of 3.8% in the BR group (p= 0.001). None of the women reported that her surgeon considered her age to be an obstacle for breast reconstruction. Women in the mastectomy group reported more fears about reconstruction than the women in the BR group (p&lt; 0.001). Patients had less opportunity to talk about their fears with their surgeon in the mastectomy group (19.4% vs 66.1% p&lt;0.001).

Conclusions: Providing dedicated information at the time of initial support is crucial in the choice of BR for women over 65. Patients' surgeons played a central role in the decision, but their GPs and husbands also provided important input. This dedicated information should help women over 65 to conclude that their age should not be a limiting factor for the decision to attempt breast reconstruction.

Citation Format: Quemener J, Wallet J, Boulanger L, Hannebicque K, Giard S, Chauvet MP, Regis C. Determinants in decision-making process of breast reconstruction in women over 65 years old [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-13-07.