Decoding Decision-Making: A Cross-sectional Study on Non-clinical Factors Influencing Surgical Choices in Indian...

Despite substantial evidence supporting comparable outcomes between Breast Conservation Therapy (BCT) and Modified Radical Mastectomy (MRM) for Early Breast Cancer, mastectomy rates remain high in most regions of India, except few metropolitan cities. Beyond clinical considerations and resource availability, sociodemographic factors and personal beliefs significantly influence Indian patients' surgical decisions. This study aimed to explore these non-clinical factors and personal beliefs impacting surgical choices among breast cancer patients eligible for BCS. In our department, 316 women underwent surgery for breast cancer between January 2020 and December 2021. Among 119 found eligible for BCS, 12 patients were excluded. Information on sociodemographic factors, individual beliefs, and influence of others in decision-making process was recorded for 107 patients on predesigned proforma. Of 107 patients included, 25 chose BCS while 82 chose MRM. On univariate analysis, education above primary school, higher income, and urban residence were found to be significantly associated (P < 0.02, P < 0.03, P < 0.02 respectively) with choice of BCS. Among patients who chose MRM, about two-third feared about recurrence or possibility of tumour being left behind while only 5% took this decision to avoid radiotherapy. Patient's desire to hide their disease and surgeon's reassurance of equivalent survival were the driving factors among patients choosing BCS. Our study reveals that sociodemographic factors significantly influence choice of surgery with higher education, higher income, and urban residence favouring BCS. Patients with greater involvement in decision-making process were more likely to choose BCS.