Breast conserving surgery versus mastectomy: cancer practice by general surgeons in Iran

Massoome Najafi,Ahmad Kaviani,Esmat Hashemi,Ali Montazeri,Mandana Ebrahimi

doi:10.1186/1471-2407-5-35

Massoome Najafi, Ahmad Kaviani + Show 3 more

Open Access

https://doi.org/10.1186/1471-2407-5-35

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Abstract

BackgroundThere appear to be geographical differences in decisions to perform mastectomy or breast conserving surgery for early-stage breast cancer. This study was carried out to evaluate general surgeons' preferences in breast cancer surgery and to assess the factors predicting cancer practice in Iran.MethodsA structured questionnaire was mailed to 235 general surgeons chosen from the address list of the Iranian Medical Council. The questionnaire elicited information about the general surgeons' characteristics and about their work experience, posts they have held, number of breast cancer operations performed per year, preferences for mastectomy or breast conserving surgery, and the reasons for these preferences.ResultsIn all, 83 surgeons returned the completed questionnaire. The results indicated that only 19% of the surgeons routinely performed breast conserving surgery (BCS) and this was significantly associated with their breast cancer case load (P < 0.01). There were no associations between BCS practice and the other variables studied. The most frequent reasons for not performing BCS were uncertainty about conservative therapy results (46%), uncertainty about the quality of available radiotherapy services (32%), and the probability of patients' non-compliance in radiotherapy (32%).ConclusionThe findings indicate that Iranian surgeons do not routinely perform BCS as the first and the best treatment modality. Further research is recommended to evaluate patients' outcomes after BCS treatment in Iran, with regard to available radiotherapy facilities and cultural factors (patients' compliance).

Highlights

There appear to be geographical differences in decisions to perform mastectomy or breast conserving surgery for early-stage breast cancer
Many randomized clinical trials have demonstrated that patient survival rates are similar after treatment by mastectomy or by conservative surgery and radiotherapy [1,2,3,4]
For 80% of the surgeons surveyed, the average number of breast cancer patients treated per year was less than 20; 20% reported that their annual case-load was more than 20

Summary

Introduction

There appear to be geographical differences in decisions to perform mastectomy or breast conserving surgery for early-stage breast cancer. Conference concluded that for most women with earlystage breast cancers (stages I and II), breast conservation surgery (BCS) is an appropriate method of treatment [5]. Despite these findings, mastectomy remains the most prevalent surgical treatment for early-stage breast cancer (page number not for citation purposes). In one study in Isfahan University of Medical Sciences, 386 breast cancer patients were reviewed and mastectomy was found to be the most prevalent surgical treatment [6]. In another study in Tehran University of Medical Sciences, 348 breast cancer patients of whom 50% had stage I or stage II breast cancer were evaluated, and it was found that only 22 patients underwent BCS [7]

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