Influences on decision for mastectomy in patients eligible for breast conserving surgery.

Increasing emphasis is being placed on low mastectomy rates. Our objective was to investigate factors influencing rates of mastectomy and breast conserving surgery. A group of 171 patients (27%) who could have had breast conserving surgery (BCS) but chose mastectomy was identified as well as all patients who underwent BCS over a 6 year period. A questionnaire asking patient's attitudes to factors which could influence their choice of operation was compiled and sent to this study group. Results showed surgical advice to be the most important factor, with significantly more influence in BCS patients. No significant difference was found in distance to treatment between the groups. Shorter duration radiotherapy would have made 47% of mastectomy patients more likely to accept BCS. BCS rates are a poor measure of quality of patient care. More emphasis should be put on choices offered to patients rather than overall uptake of a specific choice.