Abstract
BackgroundUS Asian women with early-stage breast cancer are more likely to receive a modified radical mastectomy (MRM) than White women, contrary to clinical recommendations regarding breast conserving treatment (BCT).MethodsWe surveyed physicians regarding treatment decision-making for early-stage breast cancer, particularly as it applies to Asian patients. Physicians were identified through the population-based Greater Bay Area Cancer Registry. Eighty (of 147) physicians completed a questionnaire on sociodemographics, professional training, clinical practices, and perspectives on the treatment decision-making processes.ResultsThe most important factors identified by physicians in the BCT/MRM decision were clinical in nature, including presence of multifocal disease (86% identified this as being an important factor for selecting MRM), tumor size (71% for MRM, 78% for BCT), cosmetic result (74% for BCT), and breast size (50% for MRM, 55% for BCT). The most important reasons cited for the Asian treatment patterns were patient attitudes toward not needing to preserve the breast (53%), smaller breast sizes (25%), and fear and cultural beliefs (12%).ConclusionThese survey results suggest that physicians perceive major roles of both clinical and cultural factors in the BCT/MRM decision, but cultural factors may be more relevant in explaining surgical treatment patterns among Asians.
Highlights
US Asian women with early-stage breast cancer are more likely to receive a modified radical mastectomy (MRM) than White women, contrary to clinical recommendations regarding breast conserving treatment (BCT)
We elicited physicians' perspectives on reasons why they thought Asian patients diagnosed with early-stage breast cancer are more likely to have MRM over BCT compared to the general population
Based on a small sample, we found that Asians were less likely than physicians of other ethnicities to report cosmetic result as an important factor for patients choosing BCT (OR = 0.13, 95% CI = 0.04–0.40); male physicians were more likely than females to think cosmetic result was important in BCT decisions (OR = 5.22, 95% CI = 1.76– 15.49), and less likely to perceive that patient travel concerns were important (OR = 0.21, 95% CI = 0.08–0.58)
Summary
US Asian women with early-stage breast cancer are more likely to receive a modified radical mastectomy (MRM) than White women, contrary to clinical recommendations regarding breast conserving treatment (BCT). Asian women have MRM at significantly higher rates [5,7,9,10,11]; for example, in California, among stage 0–II breast cancer patients diagnosed in 1988–1995, 67.5% of Asians had MRM compared to 57.3% of Whites [5]. This proportion is even higher among certain Asian populations; more current data from the national Surveillance, Epidemiology, and (page number not for citation purposes).
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