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Predictors of Surgical Decision-Making After Neoadjuvant Chemotherapy for Breast Cancer
Haritha Reddy1, Martina Lopez-May1, Asem Berkalieva1
1Department of Breast Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Clinical Breast Cancer
|August 11, 2026
Summary
Most breast cancer patients choose breast conserving surgery (BCS) after neoadjuvant chemotherapy (NAC). Younger age and palpable axillary lymphadenopathy may predict mastectomy choice, informing shared decision-making.
Area of Science:
- Oncology
- Surgical Oncology
- Breast Cancer Research
Background:
- Neoadjuvant chemotherapy (NAC) enables breast conserving surgery (BCS) for some breast cancer patients.
- Limited research exists on patient surgical choices post-NAC.
- Understanding predictors of surgical choice is crucial for informed decision-making.
Purpose of the Study:
- To identify clinical and demographic factors influencing surgical decisions (mastectomy vs. BCS) after NAC.
- To enhance shared decision-making processes for breast cancer patients undergoing NAC.
Main Methods:
- Retrospective chart review of breast cancer patients who became BCS candidates after NAC (2010-2020).
- Comparison of patient demographics, clinical characteristics, and surgical outcomes.
- Statistical analysis using R software (version 4.2.3) with P < .05 significance.
Main Results:
- 74.2% of 244 patients chose BCS, while 25.8% opted for mastectomy.
- Mastectomy patients were younger (48 vs. 53 years, P=.003).
- Palpable axillary lymphadenopathy was linked to higher mastectomy rates (44.4% vs. 29.3%, P=.041).
Conclusions:
- The majority of breast cancer patients select BCS after NAC-induced downstaging.
- Younger age at diagnosis and palpable axillary lymphadenopathy may predict mastectomy preference.
- These factors should be incorporated into post-NAC surgical decision-making.
