Offering choice of surgical treatment to women with breast cancer

Much has been written about the psychosocial and sexual dysfunction associated with the diagnosis and treatment of breast cancer. Hopes that breast conserving techniques would lead to a reduction in some of the psychosocial morbidity experienced, have not materialised. Most of the methodologically sound studies reported to date demonstrate few differences in quality of life domains between women whatever their primary surgical treatment. Some researchers suggested that if women were offered an opportunity to select the surgical option they preferred, then two things would occur: (1) women would choose breast-conserving techniques, and (2) choice in itself would prevent psychosocial morbidity. Despite strong support for both of these assumptions, neither have been borne out. Significant numbers of women, when offered choice, opt for mastectomy and choice in itself does not convey protection from psychological morbidity. The majority of women seem to welcome being given clear information about the options available, together with the reasons as to why a clinician would advise one policy rather than another. However, fewer women than expected wish to take a major role in decision-making about their breast cancer treatment.