Primary systemic therapy for breast cancer: Does the patient's involvement in decision-making create a new future?

<bold>Objective: </bold>Primary systemic therapy (PST) followed by surgery is the standard initial treatment for locally advanced breast cancer (LABC). However, some patients are averse to mastectomy or breast-conserving surgery and do not consent to these procedures. The reasons for this controversial decision, the factors influencing the decision-making and optimal solutions for decision aiding need to be investigated.<bold>Methods: </bold>We addressed these questions by a review of literature on the possibilities associated with different patient choices and subsequent treatment options in relation to LABC.<bold>Results: </bold>A total of 5 reviews and 22 clinical studies were summarized in relation to decision making and the most successful decision aids. A discussion is given of the issues of those few patients who cannot be convinced to undergo surgery.<bold>Conclusion: </bold>Currently there is no guideline for the treatment of patients who reject the surgical procedures after PST. Medical oncologists should be able to apply decision aid modalities in a personalized manner to give all needed information to their patients thereby ensuring a deliberate decision-making process, facilitating acceptance of a need for surgery, and thus improving the chances of prolonged survival.<bold>Practice Implications: </bold>Currently multidisciplinary tumor boards are the most suitable decision aids in oncological practice. [ABSTRACT FROM AUTHOR]