Understanding women’s decision making for and against oncoplastic breast conserving surgery as an alternative to mastectomy in early breast cancer: UK ANTHEM qualitative study

Davies, Charlotte; Conefrey, Carmel; Mills, Nicola; Fairbrother, Patricia; Holcombe, Chris; Whisker, Lisa; Skillman, Joanna; White, Paul; Macmillan, Douglas; Comins, Charles; Hollingworth, William; Potter, Shelley

Abstract

ABSTRACT

Background: Oncoplastic breast conserving surgery (OPBCS) may allow women with early breast cancer to avoid mastectomy, but many women choose more extensive surgery even when breast conserving options are offered. Reasons for this are unclear. The ANTHEM qualitative study aimed to explore factors influencing women’s surgical decision-making for and against OPBCS.

Methods: Semi-structured interviews were conducted with a purposive sample of women who had received either OPBCS or mastectomy +/- immediate breast reconstruction (IBR) to explore their rationale for procedure choice. Interviews were transcribed verbatim and analysed thematically.

Results: Twenty-seven women from 12 centres were interviewed; 12 who had chosen OPBCS and 15 mastectomy +/- IBR respectively. Overwhelmingly, women’s decisions were guided by their surgical teams with women’s decision-making for and against OPBCS influenced by three key inter-related factors: i) perceptions of oncological safety; ii) maintenance/restoration of femininity and iii) practical issues. Oncological safety was paramount. Women who felt reassured that OPBCS was oncologically safe were happy to accept this option. Those who were not were more likely to opt for mastectomy as a ‘safer’ option. Most women wished to maintain/restore femininity with the offer of IBR essential to make mastectomy an acceptable option. Practical issues such as the perceived magnitude of the surgery were a lesser concern.

Conclusions: Women’s decision-making is complex and heavily influenced by the surgical team. High-quality, accurate information about surgical options including appropriate reassurance about short- and long-term oncological safety of OPBCS is vital if women are to make fully informed decisions.

Trial registration number: ISRCTN18238549

• Journal Article Type: Article
• Acceptance Date: May 4, 2024
• Online Publication Date: Jun 15, 2024
• Publication Date: Jun 15, 2024
• Deposit Date: May 5, 2024
• Publicly Available Date: May 5, 2024
• Journal: British Journal of Surgery
• Print ISSN: 0007-1323
• Electronic ISSN: 1365-2168
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 111
• Issue: 6
• Article Number: znae133
• DOI: https://doi.org/10.1093/bjs/znae133
• Public URL: https://uwe-repository.worktribe.com/output/11977509