Preferences of Healthy Inner City Women and the Surgical Treatment of Early Stage Breast Cancer

Abstract

Numerous studies have shown that women of a lower education level and socioeconomic status use less breast-conserving surgery than women of a higher education level and socioeconomic status. Surveys of healthy women and the surgical treatment of early stage breast cancer have been performed. However, no survey has focused exclusively on inner city women. The objective of this study was to determine the awareness, preferences, and concerns of inner-city, multiethnic women and the surgical treatment of stage I and II breast cancer, and to identify if a distinct treatment preference for mastectomy or lumpectomy exists in such a population. The study consisted of a prospective survey of volunteers, age 18 years and older, in the nononcologic clinics of St. Barnabas Hospital in the Bronx, New York. We consecutively surveyed 200 women between the ages of 18 and 75 using a 12-item form from January 2004 to May 2004. Of 200 surveys, 21 were excluded as incomplete and two women surveyed who gave a prior history of breast cancer were excluded from study, leaving 177 total surveys for analysis. Women were presented with a hypothetical diagnosis of early stage breast cancer curable by mastectomy or lumpectomy and radiation therapy. Women were asked about their surgery preferences, who they would seek advice from, if they would let their physician decide treatment, and their concerns if faced with a diagnosis of breast cancer. One hundred seventy-seven completed surveys were obtained; 124 (70%) women chose lumpectomy and radiation, 48 (27%) chose mastectomy, and 5 (3%) chose no treatment. Women who were educated below the collegiate level were more likely to prefer breast conservation therapy compared with those with a college education and above (adjusted OR 1.8, 95% CI 1.0, 3.6). Overall, most women surveyed (62%) were concerned with cancer recurrence followed by the side effects of radiation therapy (19%). Most women surveyed (63%) would make their physician principal advisor, whereas some (23%) would make their significant other the principal advisor. More women who chose mastectomy would make their physician their principal advisor (80%) versus those who chose lumpectomy (65%). More than 80 per cent of the women surveyed would have their physician decide their treatment. The women in the present study exhibited a distinct preference for breast conservation therapy over mastectomy.