Breast cancer is the most common cancer in urban Indian women. Primary treatment for early cancer is surgery. In India breast conservation surgery (BCS) rates vary from 11 to 34%. This is in contrast to Western world where BCS rates exceed 70%. Little is known about the factors influencing the acceptance of BCS in backward and rural regions of India. We evaluate the factors influencing the acceptance and decision making regarding the type of surgery in breast cancer patients in rural south India.
The prospective study included all patients who presented with early breast carcinoma amenable for BCS, and who were willing for treatment. Patients were asked to fill the validated questionnaire with structured interview to assess various factors after proper consenting, initially on their own and subsequently with family members alongside. Patient, social, and surgeon-related variables, and patient satisfaction were recorded.
A total of 50 patients were enrolled with early breast cancer. 30 underwent BCS and the remaining 20 underwent modified radical mastectomy (MRM). Only 22% were aware of a surgical procedure called BCS. 90.9% of patients who were aware of the surgery opted for BCS, when compared to 51.3% among patients who were unaware. Patients from urban areas preferred BCS but literacy did not play a significant role. Patients who opted for MRM had fear of disfigurement, interference with sex life, and loss of femininity. Patients who opted for BCS had fear of second surgery and radiation exposure. 50% of patients had an initial negative attitude towards breast conservation surgery. However, after discussion of treatment strategies, 44% reported a change in attitude towards BCS.
Low rates of BCS in rural India are due to multiple factors, including patient and family member apprehensions, social considerations, and surgeon advice. The treating surgeon needs to have a good understanding of these factors and involve the patient and relatives in decision making. This would help the patient and doctor in choosing the optimum treatment in the best interest of the patient.