Recommendations for cancer treatments are developed using the best available research data. The evidence shows that these treatments are likely to lead to the best outcomes for patients. Although most early invasive breast cancer patients follow their doctor's advice, some choose not to have a recommended treatment (3% of patients diagnosed between 1998 and 2005).

Patients are more likely to decide not to have a treatment if they:

  • are older (3% refusal in patients under 40 years, 6% of patients aged 80 years or more)
  • have a surgeon with a lower annual case load (3% where the case load exceeded 100 per year, 6% where it was ≤20 per year)
  • are being treated further from a major city (3% for major cities, 5% for inner regional, 9% for more remote areas)
  • have a low grade tumour (4% for low-grade tumours, 3% for intermediate, 3% for high-grade tumours).

The table below lists breast cancer treatments from most likely to be declined (24% of treatments declined were chemotherapy) to least likely to be declined (7% of treatments declined were axillary surgery).

Treatment declined


Factors associated with declining



low case load, larger tumour

Hormone therapy


more remote treatment location, smaller tumour, lymph nodes free from cancer, less aggressive forms of cancer, tumour originating in the milk ducts



low case load, older age, treatment outside a major city

Breast conserving surgery


low case load, inner regional treatment location, fewer tumours



low case load, lack of private health insurance, lymph nodes free from cancer

Axillary (armpit) surgery


low case load, older age, less aggressive forms of cancer

More than one of the above