Changing trends in the decision-making preferences of women with early breast cancer

Background: Previous studies have indicated a predominance of passive decision‐making styles among women with early‐stage breast cancer in the UK offered a choice between breast‐conserving surgery (BCS) and mastectomy. The aim of this study was to determine current decision‐making styles and establish their association with operation choice and breast unit mastectomy rate. Methods: A questionnaire survey was conducted among women from three specialist breast units representing high, medium and low case mix‐adjusted mastectomy rates. Results: Of 697 consecutive patients, 356 (51·1 per cent) completed the questionnaire, a mean of 6·9 (range 1·3–48·6) weeks after surgery. Some 262 women (73·6 per cent) underwent BCS and 94 (26·4 per cent) had a mastectomy. Some 218 patients (61·2 per cent) achieved their preferred decision‐making style. The proportions of women achieving an active decision‐making style were high, particularly for those choosing mastectomy (83 versus 58·0 per cent for BCS; P < 0·001) and in the high mastectomy rate unit (79·6 versus 53 and 52·2 per cent for medium and low rate units respectively; P < 0·001). Conclusion: More women chose an active decision‐making style than in previous UK studies. The provision of greater treatment selection autonomy to women suitable for BCS may not reduce mastectomy rates. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Women may not always choose breast conservation