Abstract
Mastectomy rates may be affected by patient choice. 203 patients who had a Total Mastectomy for breast cancer were invited to complete questionnaires at routine follow up clinics to ascertain if they had been offered a choice of Breast Conserving Surgery (BCS), and to establish the reasons for their preference. Questionnaires were checked against medical and nursing records to confirm the reasons for the patients' choice of mastectomy. 130 patients (64%) chose to have a mastectomy, reporting that they felt safer (n = 119); wanted to decrease the risk of further surgery (n = 87) and/or wished to avoid radiotherapy (n = 34). Some were advised not to have BCS if they had a large tumour size, central or multifocal tumours and/or associated extensive microcalcification on mammography (n = 29). 24 patients had BCS as first operation but had repeat surgery for involved or narrow excision margins. Despite being advised that there is no difference between survival rates of this and breast conserving surgery, many patients still feel safer with mastectomy.
Highlights
The NHS breast screening service monitors mastectomy rates across individual regions and individual Trusts
Breast Conserving Surgery is an appropriate choice for the surgical treatment of early stage breast cancer and when combined with postoperative radiotherapy to the remaining breast tissue it provides survival equivalent to total mastectomy [1]
The North Staffordshire Breast Screening Unit had a 34.4% mastectomy rate for women diagnosed with breast cancer during the period 2000–2004
Summary
The NHS breast screening service monitors mastectomy rates across individual regions and individual Trusts. Patient choice is usually the quoted reason for some units having a higher rate, this is rarely tested. The North Staffordshire Breast Screening Unit had a 34.4% mastectomy rate for women diagnosed with breast cancer during the period 2000–2004. This compares to a national mastectomy rate of 27.8% in the United Kingdom and a 28.6% mastectomy rate for the West Midlands region (P = 0.075) [2]. Units with a higher mastectomy rate may be thought to present their patients with fewer alternatives.
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