Would Providers Choose Breast Conservation Therapy?
Paige L. Myers, MD, Rachel Y. Park, BS, Bao Tram Nghiem, MD, Ashley N. Amalfi, MD.
University of Rochester Medical Center, Rochester, NY, USA.
Background: Breast Conservation Therapy (BCT) is defined as partial mastectomy with subsequent treatment of moderate-dose radiation therapy and is the mainstay of treatment for in situ and early stage breast cancer. However, the unwanted risks of radiation must be considered when making this treatment decision. Radiation therapy not only causes acute toxic effects to the skin and surrounding organs, but also can result in chronic complications as well as future breast reconstruction options. The purpose of this study is to assess the preference of treating providers of BCT when given the hypothetical diagnosis of breast cancer of oneself or of close female family member.
Methods: A survey assessing treatment preference of three hypothetical breast cancer diagnosis scenarios were designed including ductal carcinoma in situ (DCIS), invasive ductal carcinoma (ICD) with and without lymph node invasion. The survey was distributed by American Society of Plastic Surgery via email invite to its members. Total of 207 completed responds from eligible participants were collected. All associations were evaluated with a Chi-square test and carried out using SAS® 9.4, Cary, NC: SAS Institute
Results: The risk of cancer recurrence was the most common reason for treatment preferences of all three choices. However, for DCIS unilateral mastectomy with implant based reconstruction is the most preferred option with the second most influential reason of avoiding the risks of radiation therapy. For IDC node negative, unilateral and bilateral mastectomy with implant-based reconstruction were the most preferred options also due risks of radiation therapy and also anxiety of future surveillance. For IDC node positive, bilateral mastectomy with implant based-reconstruction was the most preferred choice due to anxiety of future surveillance. No association with training level, practice type, BMI, smoking status, activity, marital status, gender. For DCIS only, younger participants favored more surgically aggressive treatment (X2 = 0.054). Nearly 75% of Plastic Surgeons would chose autologous reconstruction if their treatment required radiation therapy. All subjects opted for reconstruction (no mastectomy without recon never ranked first)
Conclusions: In general, plastic surgeons did not preferred breast conservation therapy for in situ and early stage breast cancer. Though the most common rationale for total mastectomy was risk of cancer recurrence for all disease severity, risks of radiation therapy are real and play an integral role in the decision making process. In understanding our own biases, we can help better empathize with patients in consultation for breast reconstruction.
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