V. J. Tapia4, G. F. D’Souza1, F. Qiu5, G. Nguyen3, Q. Ly2 1University Of California, San Diego,Plastic Surgery,SAN DIEGO, CA, USA 2University Of Nebraska Medical Center,Surgical Oncology,Omaha, NE, USA 3Medical College Of Wisconsin,Milwaukee, WI, USA 4University Of California – San Diego,School Of Medicine,San Diego, CA, USA 5University Of Nebraska Medical Center,College Of Public Health,Omaha, NE, USA
Introduction:
Currently accepted research in oncology has demonstrated that, in early stage breast cancer (BC), lumpectomy followed by whole breast radiation, also known as breast conservation therapy (BCT), has comparable survival to that of mastectomy. Initial investigations on surgical decision-making reported that a patient’s choice was related to socioeconomic status (SES), geographic location, patient characteristics, and physician influence. However, little research has been conducted on the influence of tumor characteristics on surgical decision-making.
Methods:
A retrospective analysis of the 2002-2010 University of Nebraska Breast Cancer Collaborative Registry was performed. The demographic, medical history, and tumor characteristics of patients were compared between oncologic surgery decision groups (BCT, unilateral mastectomy, bilateral mastectomy) in a univariate analysis. A multinomial logistic regression analysis was performed on the predictor variables that were associated with the outcome variable of surgical decision to the 0.2 significance level.
Results:
320 women were included with 100 receiving BCT, 176 unilateral mastectomy, and 44 bilateral mastectomy. On univariate analysis, factors associated with surgery decision were bilateral carcinoma (p=0.0001), staging (p=0.0006), tumor metastasis (p=0.02), tumor histology (p=0.03), BRCA mutation (p=0.04), unilateral multifocal lesions (p=0.047), and lymphoma history (p=0.04). On multinomial analysis, tumor stage and bilateral carcinoma were independently associated with treatment decision. Patients with bilateral tumors had 12.1 times higher odds of choosing bilateral mastectomy (95% OR CI: 2.3-63.3, p=0.003). When compared to patients with in situ tumors, stage II patients had 8.8 times higher odds of choosing bilateral mastectomy (p=0.048) and a 2.9 times higher odds of choosing a unilateral mastectomy (p=0.02). Subjects with stage III tumors had 32.1 times higher odds of choosing bilateral mastectomy than those with in situ tumors (p=0.007), and 13.6 times higher odds of choosing a unilateral mastectomy (p=0.0003). Stage IV patients had 36.1 times higher odds of choosing a bilateral mastectomy than those with in situ tumors (p=0.009), and an 11.5 times higher odds of choosing a unilateral mastectomy (p=0.004).
Conclusion:
Our findings suggest that our patients’ decision of surgical procedure had greater association with tumor characteristics rather than demographic or medical history, as previously demonstrated in other studies. Women with stage II-IV BC and bilateral tumors are still more likely to opt for more extensive surgical interventions despite evidence to the safety, efficacy, and comparable survival rates of more conservative treatments in patients with stages I-III, and well established education on surgical options. Patients with in situ and stage I BC may be more willing to undergo BCT, underscoring the efficacy of current patient education endeavors.