Breast cancer surgical treatment choices in Newfoundland and Labrador, Canada: Patient and surgeon perspectives

Holly Etchegary
Faculty of Medicine, Memorial University, Canada.

Elizabeth Dicks
Faculty of Medicine, Memorial University, Canada.

Farah McCrate
Cancer Care Program, Eastern Regional Health Authority, Canada.

Erin Powell
Cancer Care Program, Eastern Regional Health Authority, Canada.

Joanne Chafe
Centre for Nursing Studies, Eastern Regional Health Authority, Canada.

Rebecca Roome
Patient/community representative, Canada.

Charlene Simmonds
Health Research Unit, Faculty of Medicine, St. John’s, Newfoundland, Canada.


Background. Breast cancer remains the second-leading cause of cancer death among Canadian women. Treatment for breast cancer often includes surgery. Many women have a choice between mastectomy (MT; removal of the entire breast) or breast conserving surgery (BCS; removal of the tumour and some noncancerous breast tissue) followed by radiation. However, Newfoundland and Labrador consistently has a higher rate of mastectomies than the rest of Canada. In this project, we aim to better understand that trend.

Design and methods. A multi-method design was chosen. Surgical treatment data kept by the province will be examined to describe the number and types of breast cancer surgeries over time. Second, we will hold focus groups with women around the province who have made surgical treatment choices to explore influences on their decisions. Finally, semi-structured interviews with breast cancer surgeons and surgical residents will explore their opinions on surgical treatment choices.
Expected impact for public health. Cancer treatment choices are complex decisions, affected by clinical, demographic and social variables. Understanding why women from Newfoundland and Labrador have the highest rate of mastectomy in Canada is critical to ensure they are receiving appropriate screening and care. Greater understanding of the influences on women’s surgical choices may encourage informed decisions amongst women and physicians and promote active communication about treatment, benefits relevant to all jurisdictions and health authorities. Further, if factors such as geographic proximity to treatment facilities are associated with treatment decisions, this information is important for public health screening and service planners.