Factors influencing surgical decision-making in breast cancer: A multicenter study in Japan

Hirohito Seki; Takako Komiya; Yoshihiro Sowa; Maho Kato; Yutaka Nishida; Junji Takano; Miho Saiga; Collaborative Study Group of Scientific Research of the Japan Oncoplastic Breast Surgery Society

doi:10.1016/j.ejso.2026.111739

Factors influencing surgical decision-making in breast cancer: A multicenter study in Japan

Eur J Surg Oncol. 2026 May;52(5):111739. doi: 10.1016/j.ejso.2026.111739. Epub 2026 Mar 7.

Authors

Hirohito Seki¹, Takako Komiya², Yoshihiro Sowa³, Maho Kato⁴, Yutaka Nishida⁵, Junji Takano⁶, Miho Saiga⁷; Collaborative Study Group of Scientific Research of the Japan Oncoplastic Breast Surgery Society

Affiliations

¹ Department of Breast Surgery, NHO Tokyo Medical Center, Tokyo, Japan. Electronic address: hirohito.seki@gmail.com.
² Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan.
³ Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan.
⁴ Department of Plastic Surgery, Aichi Medical University Hospital, Aichi, Japan; Division of Plastic Surgery, Kamiiida Daiichi General Hospital, Aichi, Japan.
⁵ Center for Data Science Education and Research, Kyorin University, Tokyo, Japan.
⁶ Department of Plastic Surgery, Saitama Medical Center, Saitama, Japan.
⁷ Department of Plastic Surgery, Okayama University Hospital, Okayama, Japan.

PMID: 41812477
DOI: 10.1016/j.ejso.2026.111739

Abstract

Background: Recent advances in cancer treatment and improvements in prognosis have led to increasing recognition of the critical role of shared decision-making (SDM) between patients and healthcare providers in determining treatment strategies. SDM requires not only information on surgery-related outcomes and health-related quality of life, but also consideration of patient-specific factors such as the social background. However, determinants of surgical choice among Japanese patients remain unclear, and this study aimed to identify the influencing factors.

Methods: This multicenter, cross-sectional study evaluated patient-reported outcomes in 577 Japanese patients who underwent mastectomy (MT), breast-conserving surgery (BCS), or immediate breast reconstruction (IBR). Participants completed questionnaires to assess the factors influencing surgical decision-making, including sociodemographic, psychosocial, and healthcare provider-related factors. Clinical data were obtained from the medical records, and multivariate analyses were conducted to identify the factors associated with the selection of surgical procedures.

Results: The most frequently cited factor was the surgeon's opinion (92.2%), followed by fear of recurrence (43.8%) and partner's opinion (35.5%). Partner's opinion was significantly more influential in BCS and IBR selection than in MT selection (P = 0.012), whereas concern about recurrence was the main factor influencing MT selection (P = 0.002). Multivariate analysis suggested the nurse's opinion was significantly associated with IBR, while concern about recurrence was inversely related.

Conclusions: Considering that the factors influencing decision-making vary by surgical procedure, it is essential to tailor surgical choices to each patient's values and lifestyle. Strengthening decision-support systems by involving the entire healthcare team will be an important priority moving forward.

Keywords: Breast cancer; Breast reconstruction surgery; Decision-making factor; Patient-reported outcome; Shared-decision making.

Publication types

Multicenter Study

MeSH terms

Adult
Aged
Breast Neoplasms* / psychology
Breast Neoplasms* / surgery
Cross-Sectional Studies
Decision Making*
Decision Making, Shared*
Female
Humans
Japan
Mammaplasty*
Mastectomy*
Mastectomy, Segmental*
Middle Aged
Patient Reported Outcome Measures
Quality of Life
Surveys and Questionnaires