RESUMO
Increasing emphasis is being placed on low mastectomy rates. Our objective was to investigate factors influencing rates of mastectomy and breast conserving surgery. A group of 171 patients (27%) who could have had breast conserving surgery (BCS) but chose mastectomy was identified as well as all patients who underwent BCS over a 6 year period. A questionnaire asking patient's attitudes to factors which could influence their choice of operation was compiled and sent to this study group. Results showed surgical advice to be the most important factor, with significantly more influence in BCS patients. No significant difference was found in distance to treatment between the groups. Shorter duration radiotherapy would have made 47% of mastectomy patients more likely to accept BCS. BCS rates are a poor measure of quality of patient care. More emphasis should be put on choices offered to patients rather than overall uptake of a specific choice.
Assuntos
Neoplasias da Mama , Comportamento de Escolha , Aconselhamento Diretivo , Mastectomia , Tratamentos com Preservação do Órgão , Radioterapia Adjuvante/psicologia , Adulto , Atitude Frente a Saúde , Austrália/epidemiologia , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/psicologia , Neoplasias da Mama/cirurgia , Aconselhamento Diretivo/métodos , Aconselhamento Diretivo/normas , Aconselhamento Diretivo/estatística & dados numéricos , Definição da Elegibilidade , Feminino , Humanos , Mastectomia/métodos , Mastectomia/psicologia , Mastectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/métodos , Tratamentos com Preservação do Órgão/psicologia , Tratamentos com Preservação do Órgão/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Melhoria de Qualidade , Radioterapia Adjuvante/métodos , Inquéritos e QuestionáriosRESUMO
AIM: To investigate the effect of breast cancer, its treatment and counselling on future pregnancy and fertility. METHOD: Three hundred and four women 45 years and younger at the time of diagnosis of breast cancer were identified from one breast unit from 1997 to 2006. A questionnaire was sent to all patients asking about pregnancy, counselling and fertility issues. RESULTS: Of 304 women, 248 were still alive and not lost to follow up. The questionnaire response rate was 66% and the average follow up was 60 months. By questionnaire response, 39 women had wanted children before diagnosis, and 24 still wanted them post treatment, giving a successful pregnancy rate of 75%. Eighteen patients have become pregnant, 4 with more than one pregnancy. 107 patients were specifically counselled about fertility prior to breast cancer treatment. The mortality due to breast cancer was 10% in non-pregnant patients and 6% in patients who became pregnant after breast cancer. CONCLUSION: Pregnancy after breast cancer does not confer a poor prognosis. A higher rate of pregnancy than expected was found after treatment, possibly due to newer treatments including fertility preservation and also possibly due to the active counselling programme in this unit. Patients should have active counselling about fertility when planning treatment and fertility conservation can then be incorporated into a treatment plan.