Surgeons’ Recommendation is the Factor in Determining the Breast Cancer Surgery Procedures: an Experience from Rural Hospital in Thailand

Abstract

Introduction: The majority of breast cancer patients in rural hospital in developing countries still warrant for total<br />mastectomy. Surgeon advice regard surgical procedure is one of the most important factors in decision making. Our<br />study aims to compare the rate of breast-conserving surgery (BCS), mastectomy (MT) and mastectomy with immediate<br />breast reconstruction (MTIBR) between the surgeons who offer only MT (group A) and who offer BCS MT and MTIBR<br />(group B). Method: A retrospective cohort study was conducted at Ratchaburi hospital, Thailand from January 2010<br />to April 2014. We categorized patients into 2 groups (group A and B). Univariated analysis was selected to determine<br />the factors that associated with the breast surgery procedures. Results: From January 2010 to April 2014, we recruited<br />310 breast cancer patients, 221 patients (71.2%) were treated by surgeons in group A, 89 patients (28.7%) by surgeons<br />in group B. The choice of breast surgery is significantly different between 2 groups (P<0.001). In group A, 213 (96.3%)<br />patient had MT and only 3 (1.3%) BCS and 5 (2.2%) MTIBR. Whilst in group B, 58 (65.1%) patient had MT and<br />11 (12.3%) BCS and 20(22.4%) MTIBR. Choice of breast surgery in patients with stage 1,2,3 are significantly different<br />between 2 groups (P=0.004, <0.001, 0.025 respectively). Age is the only factor that significantly affects the choice<br />of surgery in the group B but not in group A. Conclusion: Surgeon's competency and comprehensive preoperative<br />consultation by offering BCS, MT and MTIBR can affect the choice of surgical procedure for breast cancer patient.