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Monday, October 20, 2008: 1:45 PM
Grand Ballroom B/C (Hyatt Regency Penns Landing)
Purpose: To evaluate the association between patient involvement in decision making and mastectomy use among a large, population-based sample of racially/ethnically diverse breast cancer patients.
Methods: 2030 women with breast cancer diagnosed between 8/05-5/06 and reported to the LA SEER registry were identified and surveyed about 9 months after diagnosis. Latinas and African Americans (AA) were over-sampled (N=1338, eligible response rate 71%). We compared the proportion of women who received mastectomy by race/ethnic groups (white, AA, and Latina low and high acculturation, determined by the Short Acculturation Scale for Hispanics) and level of decision involvement (surgeon-based, shared, or patient-based, determined from the Control Preferences Scale) adjusting for other demographic and clinical variables. We also examined the role of patient attitudes, including concerns about recurrence, radiation and body image. Results: 911 patients with no clinical contraindications to BCS and less than stage III were studied (29% white, 24% AA, 20% Latina-low, 22% Latina-high). Sixteen percent initially received mastectomy. Thirty-five percent of women reported a patient-based decision, 37% a shared decision, and 28% a surgeon-based decision. Neither receipt of mastectomy nor decision involvement varied by race/ethnic group. Women who reported a patient-based decision were much more likely than those who reported a shared or surgeon-based decision to have received mastectomy (25% vs. 12% and 6%, respectively, P<0.001). This association was significant and consistent across race/ethnic groups. Concerns about recurrence and radiation were strongly associated with mastectomy across race/ethnic groups (p<0.001) while concern about body image was not. There was a strong interaction between decision involvement, patient attitudes and mastectomy use.Conclusions: Patient-based decisions strongly favored receipt of initial mastectomy even for Latinas with different levels of acculturation. Further work to evaluate the quality of this decision is needed.
Methods: 2030 women with breast cancer diagnosed between 8/05-5/06 and reported to the LA SEER registry were identified and surveyed about 9 months after diagnosis. Latinas and African Americans (AA) were over-sampled (N=1338, eligible response rate 71%). We compared the proportion of women who received mastectomy by race/ethnic groups (white, AA, and Latina low and high acculturation, determined by the Short Acculturation Scale for Hispanics) and level of decision involvement (surgeon-based, shared, or patient-based, determined from the Control Preferences Scale) adjusting for other demographic and clinical variables. We also examined the role of patient attitudes, including concerns about recurrence, radiation and body image. Results: 911 patients with no clinical contraindications to BCS and less than stage III were studied (29% white, 24% AA, 20% Latina-low, 22% Latina-high). Sixteen percent initially received mastectomy. Thirty-five percent of women reported a patient-based decision, 37% a shared decision, and 28% a surgeon-based decision. Neither receipt of mastectomy nor decision involvement varied by race/ethnic group. Women who reported a patient-based decision were much more likely than those who reported a shared or surgeon-based decision to have received mastectomy (25% vs. 12% and 6%, respectively, P<0.001). This association was significant and consistent across race/ethnic groups. Concerns about recurrence and radiation were strongly associated with mastectomy across race/ethnic groups (p<0.001) while concern about body image was not. There was a strong interaction between decision involvement, patient attitudes and mastectomy use.Conclusions: Patient-based decisions strongly favored receipt of initial mastectomy even for Latinas with different levels of acculturation. Further work to evaluate the quality of this decision is needed.