Objective: We sought to investigate attitudes toward breast-conserving therapy (BCS) in early-stage breast cancer (EBC) patients from P. R. China and assess the factors influencing their decision. Background: There exists geographical difference in decision to perform mastectomy or BCS for EBC patients. To date, there has been no report on attitudes toward BCS or factors influencing the surgical choice in mainland China. Methods: A structured questionnaire was delivered to 1800 EBC patients. The questionnaire elicited information about general patients' characteristics, attitudes toward BCS, the roles of doctors and spouses, the levels of understanding of BCS, and the reasons for their preferences. Results: Of 1590 participants, only 7.3% anticipated BCS and this was significantly associated with patient age, income, occupation, martial status, education, levels of selfunderstanding of the disease, and doctors' and spouses' suggestions (Po0.05). Approximately 70% of doctors (71.0%) and 40% spouses (39.6%) advised patients not to conserve their breasts. Although the percentage of patients endorsing BCS was higher than that of those opposing it (43.7 vs 15.1%) and more patient believed BCS was beneficial for women (39.2%), even if given another opportunity, only 32.5% of patients preferred to choose it. Moreover, the level of understanding BCS among patients is low (well-known: less-known: never-heard, 2.3 vs 47.4 vs 13.3%). Conclusions: These results suggested that Chinese EBC patients lack accurate and comprehensive understanding of BCS. More efforts are needed to educate breast cancer patients in mainland China toward BCS. Copyright (C) 2011 John Wiley & Sons, Ltd.