Decision involvement and mastectomy use among racially/ethnically diverse breast cancer patients

Abstract

6511 Background: Prior research suggests that more patient involvement in treatment decisions is associated with receipt of mastectomy. This study addresses this issue using a large, population-based sample of racially/ethnically diverse breast cancer patients. Methods: 2,030 women with breast cancer diagnosed between 8/05–5/06 and reported to the LA SEER registry were identified and surveyed about 9 months after diagnosis. Latinas and African Americans (AA) were over-sampled (N=1,338, eligible response rate 71%). We compared the proportion of women who received mastectomy by race/ethnic groups (white, AA, and Latina low and high acculturation, determined by the Short Acculturation Scale for Hispanics) and level of decision involvement (surgeon-based, shared, or patient-based, determined from the Control Preferences Scale) adjusting for demographic and clinical variables. We also examined the role of patient fear of recurrence on receipt of surgery. Results: 911 patients with no clinical contraindications to BCS stage 0-II were studied (29% white, 24% AA, 20% Latina-low, 22% Latina- high). 15% of women initially received mastectomy. 35% of women reported a patient-based decision, 37% a shared decision, and 28% a surgeon-based decision. Neither receipt of mastectomy nor decision involvement varied by race/ethnic group. Women who reported a patient- based decision were much more likely than those who reported a shared or surgeon-based decision to have received mastectomy (25% vs. 12% and 6%, respectively, P<0.001). This association was significant and consistent across race/ethnic groups (Table). Among women with patient-based decisions, fear of recurrence was strongly associated with mastectomy across race/ethnic groups (p<0.001). Conclusions: Patient-based decisions strongly favored receipt of initial mastectomy even for Latinas with different levels of acculturation. Some women may be subject to over treatment because of inaccurate perceptions about disease recurrence. Receipt of mastectomy by race/ethnicity and decision involvement Decision involvement Latina-Low (%) Latina-High (%) AA (%) White (%) Surgeon 8 6 4 5 Shared 15 11 11 10 Patient 29** 36** 18* 21* ** P<0.001; * P<0.01 No significant financial relationships to disclose.