Physician perspectives on surgical treatment disparities among Asian women with early stage breast cancer

A54

Asian women with early stage breast cancer have modified radical mastectomy (MRM) instead of breast conserving treatment (BCT) at significantly higher rates than white women, despite evidence that BCT provides a less invasive alternative to MRM with equivalent survival and the promise of a better quality of life. These patterns can not be completely explained by the socio-demographics of the patient or clinical characteristics of the tumor. Qualitative research suggests that traditional Asian cultural characteristics and beliefs about physical appearance, fate and safety and effectiveness of BCT, as well as difficulties with adjuvant treatment and cross-cultural misunderstandings in the doctor-patient encounter may explain the seeming preference for MRM. As part of a larger pilot study to identify factors responsible for this treatment disparity, we conducted a survey of physicians to ascertain their perspectives about reasons for the higher rates of mastectomy among Asians as well as general factors determining treatment decision-making for early stage breast cancer.
 Physicians were identified through the population-based cancer registry for the Greater San Francisco Bay Area. We generated an eligibility sample of attending and follow-up physicians who had diagnosed and/or treated proportionally the most Chinese, Vietnamese and Filipina breast cancer patients during the years 2002-2004 based on registry-recorded race/ethnicity, with 50 physicians associated with each ethnicity. Eighty (of 147 eligible) physicians completed a questionnaire on socio-demographics, professional training, clinical practices, and perspectives on the treatment decision-making processes.
 74% of physicians considered cosmetic result to be important in determining treatment with BCT in general. 53% of physicians believed Asian women are more likely to have MRM because of patient attitude toward [not] preserving the breast, and 25% believed breast size plays a strong role. Physicians also listed fear and/or cultural beliefs as other factors influencing MRM decisions among Asian women (5%). Asian physicians were more likely than non-Asian physicians to perceive the importance of patient age (OR=5.00, 95% CI=1.10-22.63) and travel concerns (OR=7.65, 95% CI=1.38-42.56) in explaining the Asian treatment difference.
 The perspectives of physicians suggest that while the main factors in deciding between BCT and MRM in general are clinical in nature, the primary reasons for the observed differences in surgical treatment patterns among Asian women are believed to be cultural in nature. Culturally-influenced factors include patient attitude toward the breast and the role of breast size. The role of patient-provider cultural concordance may also be relevant when examining Asian physicians perspectivesâ\#8364;™ on decision-making process and treatment factors. The increase in likelihood that Asian physicians perceived difficulty in travel to receive adjuvant therapy (required as part of the full course of BCT) as a reason for selecting MRM over BCT may be an example of this phenomenon.