I have found that Welsh women, as part of the Welsh culture, are much more practical.

Dr Simon Holt

Dr Holt suggested that Welsh women are more prepared to undergo radical surgery because they were not as "image conscious" as English women.

The report for the Welsh Assembly's Health and Social Services Committee highlights a number of issues with cancer care in Wales.

One issue is the higher levels of mastectomies in Wales than England.

In England, 44% of breast cancer operations involve breast removal. In Wales the figure is 52%.

The report says this is the result of a apparent lack of patient involvement in making decisions about their treatment.

It said that most women will prefer breast-conserving surgery for localised tumours where survival rates are the same.

More radical: Welsh breast cancer patients

The report argues that geographical differences such the travel time to and from hospital may also have an impact on the figures.

It suggests that the figures point to patients either not being given a choice or being overly influenced by consultant preferences.

But this theory is disputed by Dr Holt who said he noticed cultural differences over the issues involved immediately he started working in Wales.

He said that his Welsh patients have seemed much more ready to make the decision to opt for the radical surgery, mastectomy, rather than the prolonged series of consultations and assessments involved in the breast-conserving procedures.

"Mastectomies are usually more final," he said.

"Conserving incisions can often involve further surgery and therapy which can disrupt work and life patterns.

"Having worked in the home counties and spent the last 10 years in Wales, I have found that Welsh women, as part of the Welsh culture, are much more practical.

"In rural areas some patients may have to travel long distances for treatments.

"Welsh women are not as obsessed with self-image."