AN EXAMINATION OF WHY SASKATCHEWAN WOMEN CHOOSE MASTECTOMY VERSUS BREAST CONSERVATION THERAPY IN EARLY STAGE BREAST CANCER
Bibliographic record
Abstract
Introduction and Research Purpose Breast cancer is the most commonly diagnosed cancer in North America and the second most common cause of cancer death in women. For early stage breast cancer (ESBC), it is well established that breast conservation therapy (BCT) and mastectomy are equivalent treatments for survival. Treatment for ESBC can therefore be viewed as preference sensitive care, where decision-making between treatment options should vary according to patient preferences. In Canada, interprovincial mastectomy rates vary greatly from 25% to 68% between provinces with a national average of 38%. Saskatchewan has consistently reported the nation’s second highest mastectomy rate with the latest report showing 63%. There has been international research investigating why women choose mastectomy versus BCT, but there is limited data within Canada to explain these provincial variations. The aim of my thesis is to better understand Saskatchewan women’s choice between mastectomy and BCT in ESBC. In this dissertation, I have addressed the research objectives through four manuscripts outlined below Manuscript 1: To assess the current evidence, we conducted the first systematic review on the factors influencing women’s choice of mastectomy versus BCT in ESBC. Manuscript 2: To identify the factors that influence Saskatchewan women’s choice between BCT or mastectomy in ESBC, we conducted a province-based qualitative study which identified themes and subthemes influencing therapy choice. This was the first part of an exploratory mixed methods study. Manuscript 3: To help improve our understanding and organize our research, we created a conceptual framework of why women choose mastectomy versus BCT in ESBC. This framework was important in organizing our systematic review and guiding our survey. Manuscript 4: Finally, to understand decision-making influences of Saskatchewan women with ESBC, we conducted a province wide survey. Creation of this survey was grounded on our previous work and the second portion of our mixed methods study. Results and Conclusion Our research demonstrates treatment choices for Saskatchewan women with ESBC were primarily influenced by disease stage and individual belief factors. These findings would suggest that women are making their treatment choices predominantly based on individual values and preferences. The use of mastectomy and BCT rates as an indicator of quality of care may be misleading. Instead, a shift in attention towards patient-centred care is more appropriate.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.035 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.006 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".