Why did 43% of women in South Dakota with early-stage breast cancer choose mastectomy rather than lumpectomy? A survey indicated that their choices were based on the stage of their cancer.

“According to research evidence, survival rates are considered equal,” explained dean Nancy Fahrenwald, PhD, RN, of the South Dakota State University College of Nursing in Brookings.

Working through the South Dakota Women’s Cancer Network, the South Dakota Comprehensive Cancer Control Program, and seven cancer treatment centers in the state, Fahrenwald collected responses from 1,093 breast cancer survivors whose diagnosis came in the last 5 years.

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Fahrenwald had divided the sample into three groups based on where the women lived: urban, large rural, and small rural. The women in the small rural group did not have access to care in the nearest town, whereas those classified in the large rural group, such those women living near Aberdeen, might have a cancer treatment center nearby, she explained.

Distances to surgery and to treatment were considered one variable because their covariants were highly correlated. However, distance was not found to account for the variation in the patients’ choices.

“This finding dispels prior evidence that women who must travel further choose a mastectomy,” Fahrenwald said, noting that this will impact people’s thinking about rurality.

When looking at age as a determining factor, the nursing researchers found that 20- to 30-year-olds and those older than 75 years tended to choose the more surgically invasive treatments, Fahrenwald explained. Young women with early stage cancer in one breast chose bilateral mastectomy, often with reconstruction, then chemotherapy and even gene therapy.

After narrowing the analysis down to those women who discussed both lumpectomy and mastectomy with their surgeons, the researchers concluded that the most significant factor to predict treatment choice is the stage of the woman’s breast cancer.

Among the 415 women who considered both options, 109 were at stage 0, 186 at stage 1, and 120 at stage 2. The majority of those at stage 0 and stage 1 chose lumpectomy, 57.7% and 65.6%, respectively, which was a statistically significant relationship.

However, the women with stage 2 cancer had a tendency to choose the more surgically extensive treatments, as nearly 58% opted for mastectomy.

This collaborative work will provide “statistically rigorous justification for the relationships that are leading to perceptions that rural community members are choosing mastectomy,” Fahrenwald said. That will then help formulate public health policies to encourage patient-centered treatment decisions where options are provided and women make an informed choice and are highly satisfied with that choice.