Factors associated with patients in the Scottish Highlands who chose mastectomy when suitable for breast conservation

Both breast conservation surgery (BCS) with adjuvant radiotherapy and mastectomy offer equivalent oncological outcomes for women with newly diagnosed breast cancer, yet some women offered BCS choose to undergo mastectomy (1,2). The issue of variation in mastectomy rates has been highlighted within the UK (3). Analysis of the Trent Breast Screening Programme database [1997–2003] found statistically significant variations in the surgical management of early stage breast cancer with regards to mastectomy rates. The authors conclude that the variation in mastectomy rates within the programme cannot be accounted for by case-mix alone and recommend further research to investigate the potential factors influencing the type of surgery in breast cancer. Similar variation has been highlighted in the United States (4,5)