Determinants of Breast-Conserving Therapy in Early-Stage Breast Cancer Patients: A Nationwide Study

Evidence from previous studies and treatment guidelines suggested that breast-conserving therapy (BCT) is the treatment of choice for early-stage breast cancer. However, in the last decades, surgeons have noticed a high percentage of mastectomies done in this population. The aim of this study is to explore the factors associated with not choosing BCT among eligible patients with early-stage breast cancer. This study uses a retrospective cohort design. Demographic and clinical characteristics derived from The Taiwan Cancer Registry Database, the National Health Insurance Database and the Death File Database from January 1, 2004 to December 31, 2014. Patients were followed until December 31, 2015. To explore the associated factors related to BCT, we used univariate and multivariate logistic regression analysis. A total sample of 25,967 stage I breast cancer patients was included. Among them, 12,191 underwent BCT and 13,776 underwent mastectomy as their primary treatment. The logistic regression analysis reveals that age, pay-for-performance (P4P) program participation, number of affected lymph nodes, tumor size and location, were determinants of BCT. Interestingly enough, histological type did not reach the significance level. This study shows that personal and clinical characteristics influence the treatment choice in stage 1 breast cancer patients. Breast-conserving therapy is the recommended treatment for early-stage breast cancer but has not been universally adopted. This study used nationwide data and found that some demographic and clinical factors, such as age, pay-for-performance program participation, number of affected lymph nodes, tumor size, and tumor location, are associated with the use of breast-conserving therapy.