Mastectomy or conservation: the patient's choice

Abstract

Study objective: To determine whether, if given the choice, patients with breast cancer would prefer mastectomy or conservation treatment, neither treatment having been shown to be preferable.

Design: Non-randomised case series with 28 patients interviewed after two years and all followed up.

Setting: Secondary care referral centre.

Patients: 153 women, aged less than 65, with T1, T2, N1, and N0 tumours of the breast given the choice of treatment (that is, all eligible patients from December 1979).

Interventions: Patients were asked, after information and counselling, which treatment they would prefer. The chosen treatment was given without further question. Mastectomy included node sampling and local radiotherapy if indicated. Conservation treatment comprised excision of the lump, external radiotherapy, and irridium wire implant to tumour bed.

Main results: Conservation treatment was chosen by 54 women and mastectomy by 99. Reasons for preferring mastectomy included desire for rapid treatment for domestic or employment reasons and fear of possibility of future mastectomy. Only two of the sample interviewed regretted their choice. During limited follow up no advantages to either form of treatment were seen in terms of recurrence or survival.

Conclusions: Patients with breast cancer are capable of choosing treatment and should play a part in deciding which treatment to have. They do not automatically choose to retain the breast.