P1-11-03: Breast Conserving Surgery or Mastectomy – An Urban Bias? A Rural Surgical Patient Population and Factors That Lend to Therapeutic Decisions in Breast Cancer.
Authors: Wooldridge RD , Borgstrom DC 
Published: June 2012

Introduction: For women with early stage breast cancer, it is accepted that BCS followed by radiation therapy yields equivalent results to mastectomy. Over the past 20 years, rates of women choosing BCS have increased. However, the national mastectomy rate remains high. Multiple influential factors have been investigated in efforts to define those that aid in surgical decision making, including age, race, education concerning surgical options, and the influence of their surgeon and discussion regarding surgical options. Our study centered on our rural breast cancer population, anticipating that a woman's surgical choice might be affected by unique rural factors not present in an urban setting.

Methods: Stage 0-II breast cancer patients were identified using the Tumor Registry for 1/2000 through 12/2008. Patients were divided into two groups based on surgical procedure, BCS or mastectomy, and mailed a survey. Questions included basic demographics in addition to concerns of recurrence, driving distance to the nearest radiation center, potential need for another operation, influence by educational materials or family members, discussion of options with their surgeon, as well as if they sought a second opinion. Responses were assigned values using a Likert scale. Univariate analyses were performed to detect relationships between surgery choice and survey variables. Those variables found to be significant at the univariate level were entered into a multivariate logistic regression model predicting the probability of mastectomy versus BCS.

Results: An overall response rate of 83.1% was achieved, with a total of 283 completed surveys. The mean age at the time of surgery was 61.1 years (SD 9.3), which was not statistically significant. The univariate analyses detected four statistically significant variables related to surgical choice — the worry about recurrence (91.6% mastectomy patients, 55.4% BCS patients: p-value &lt;0.0001), a faster return to “normal life” (51.7% mastectomy patients, 69.9% of BSC patients: p-value 0.039), avoiding another operation (68.9% mastectomy patients, 45.2% BCS patients: p-value 0.012), and having obtained a second opinion (30.5% of mastectomy patients, 16.7% BCS patients: p-value 0.036). There was no difference in surgical choice when comparing for age, level of education, distance from a radiation center, or concerns about driving in inclement weather. The resulting multivariate logistic regression model showed the strongest independent predictor of surgical choice to be worry about breast cancer recurrence, with a p-value of 0.0005 and an odds ratio of 6.1 (95% CI 2.2−16.7). The desire for a faster return to a normal life was also significantly predictive in this model. Regarding the patient's impression of the discussion with their surgeon about their surgical options, 95.2% of mastectomy patients and 89.2% BCS patients stated that their surgeon discussed both as surgical choices.

Conclusions: Anticipated rural-unique factors were not related to surgical decision making in our population of early stage breast cancer patients. Concern about breast cancer recurrence was the most strongly associated factor in the choice of mastectomy over BCS.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-11-03.