A question of choice: results of a prospective 3-year follow-up study of women with breast cancer

The objective of this study was to determine the impact of offering women choice in decision-making about surgery in early breast cancer. We examined how women felt about choosing, which choices they made and the effect that choosing had on psychiatric morbidity over 3 years. 269 women with stage I or II breast cancer were treated by three groups of surgeons, who either favoured mastectomy or breast conserving surgery or who offered patients choice whenever possible. Results revealed that a significant minority of women experienced unremitting psychiatric morbidity, irrespective of surgeon group or actual surgery performed. At 3 years, 19% of women were clinically anxious and 15% were depressed. With 3-year follow-up, the relative risk (95% CI) for psychiatric morbidity was less in women treated by ‘choice' surgeons, compared to women treated by surgeons favouring mastectomy (p < 0.05). 62 women were eligible to choose their surgery, and of these 8 (13%) were unable to make a decision. Difficulty was experienced by 2362 (37%) of women. Nevertheless, 2662 (42%) felt pleased that they had been allowed to choose, although others had some reservations about the process. Only 5 women expressed doubts about their original decision. There was no evidence that choice in itself prevents psychiatric morbidity in women treated for breast cancer.