Breast conserving surgery versus mastectomy: cancer practice by general surgeons in Iran

A structured questionnaire was mailed to 235 general surgeons chosen from the address list of the Iranian Medical Council. The questionnaire elicited information about the general surgeons' characteristics and about their work experience, posts they have held, number of breast cancer operations performed per year, preferences for mastectomy or breast conserving surgery, and the reasons for these preferences.In all, 83 surgeons returned the completed questionnaire. The results indicated that only 19% of the surgeons routinely performed breast conserving surgery (BCS) and this was significantly associated with their breast cancer case load (P < 0.01). There were no associations between BCS practice and the other variables studied. The most frequent reasons for not performing BCS were uncertainty about conservative therapy results (46%), uncertainty about the quality of available radiotherapy services (32%), and the probability of patients' non-compliance in radiotherapy (32%).The findings indicate that Iranian surgeons do not routinely perform BCS as the first and the best treatment modality. Further research is recommended to evaluate patients' outcomes after BCS treatment in Iran, with regard to available radiotherapy facilities and cultural factors (patients' compliance).Many randomized clinical trials have demonstrated that patient survival rates are similar after treatment by mastectomy or by conservative surgery and radiotherapy [1-4]. However, the National Institute of Health Consensus Conference concluded that for most women with early-stage breast cancers (stages I and II), breast conservation surgery (BCS) is an appropriate method of treatment [5]. Despite these findings, mastectomy remains the most prevalent surgical treatment for early-stage breast cancer in many parts of the world. In Iran, BCS is an uncommon modality for this condition. For example, in one study in Isfahan University of Medical Sciences, 386 breast cancer patients were reviewed and maste