The Family and Surgeon Influences on Breast Cancer Surgery in Premenopausal Women in a War-Conflict Country: Experience from Iraq

Abstract

Background: The surgical treatment of breast cancer in premenopausal women poses special difficulties in war-torn countries, where comorbidities, surgeons, and family members play a major role in the decision-making process.

Objectives: This study aims to investigate the effect of these factors on the surgical decisions and to identify areas where patient outcomes and healthcare practices will be improved.

Methods: This quantitative study was conducted across three areas affected by conflict within the Kurdistan Region, Iraq. Semi-structured interviews and focus group discussions were performed with premenopausal women who were diagnosed with breast cancer, their families, and their surgeons. We reviewed medical records to find out the types of surgical treatments carried out and the presence of comorbid conditions. Thematic analysis and narrative inquiry were employed to interpret the data.

Results: The results indicate that Wide Local Excision (WLE) was chosen in 43.9% of cases. The second most common surgery was mastectomy, 39.3%. Surgeons made the majority of surgical decisions (34.5%), with family members having a significant influence as well (29.3%). Another important finding was the high percentage of patients who did not have comorbidities (86.4%), which affect-ed the surgical treatment options and results positively.

Conclusion: The current study highlights the high authority of surgeons and the significant influence of family members in the decision-making process. This reflects the lack of patients’ autonomy, maybe due to cultural norms, social factors, and stress that is caused by living in war-conflict countries. Increasing patient autonomy in making decisions about choosing treatment modalities can also result in more tailored and successful treatment outcomes.

Keywords: Breast cancer, Family influence, Premenopausal women, Surgical decision-making, War-torn countries.