Addressing the paradox of increasing mastectomy rates in an era of de-escalation of therapy: Communication strategies

Breast conservation therapy (BCT) was established as the preferred modality of surgical treatment for early stage breast cancer in the early 1990's. Yet, rising mastectomy rates have been observed over the last decade. This increase is a cause for concern as recent large population-based studies have consistently reported improved breast cancer-specific survival and local control rates with BCT, in comparison with mastectomy. There is a pressing need to formulate strategies to effectively inform both patients and practitioners about current data, in the hope of reversing rising mastectomy rates to optimise survival outcomes. Based on the available evidence relating to the motivators for a mastectomy, a format for presenting data to bridge the existing knowledge deficit for effective patient counselling is proposed in this review.