Increased Mastectomy Use in Patients With Early-Stage Breast Cancer
In a national retrospective cohort study reported in JAMA Surgery, Kummerow et al found that an increased proportion of women with breast cancer eligible for breast-conserving surgery have undergone mastectomy during recent years.
The study involved data from > 1.2 million women with early-stage breast cancer in the National Cancer Database treated between January 1998 and December 2011 at centers accredited by the American Cancer Society and the American College of Surgeons Commission on Cancer.
Increasing Proportion
A total of 35.5% of the study cohort underwent mastectomy. The proportion of women eligible for breast-conserving surgery who underwent mastectomy increased from 34.3% in 1998 to 37.8% in 2011 (P < .001 for trend).
On multivariate analysis for the 8 most recent years adjusting for age, race, Hispanic ethnicity, payer status, urban vs rural residence, Charlson-Deyo comorbidity score, treating facility type, treating facility geographic region, educational level, invasive vs in situ disease, tumor size, nodal status, and estrogen receptor status, women eligible for breast-conserving surgery were 34% more likely to undergo mastectomy in 2011 compared with 2003 (odds ratio [OR] = 1.34, 95% confidence interval [CI] = 1.31–1.38). Rates of increase in use of mastectomy were greatest in women with clinically node-negative disease (OR = 1.38, 95% CI = 1.34–1.41) and in situ disease (OR = 2.05, 95% CI = 1.95–2.15).
Breast Reconstruction and Bilateral Mastectomy
Among women undergoing mastectomy, rates of breast reconstruction increased from 11.6% in 1998 to 36.4% in 2011 (P < .001 for trend). Rates of bilateral mastectomy in women with unilateral disease increased from 1.9% in 1998 to 11.2% in 2011 (P < .001 for trend).
The investigators concluded: “In the past decade, there have been marked trends toward higher proportions of [breast-conserving surgery]-eligible patients undergoing mastectomy, breast reconstruction, and bilateral mastectomy. The greatest increases are seen in women with node-negative and in situ disease. Mastectomy rates do not yet exceed current American Cancer Society/American College of Surgeons Commission on Cancer accreditation benchmarks. Further research is needed to understand factors associated with these trends and their implications for performance measurement in American Cancer Society/American College ofSurgeons Commission on Cancer centers.”
Kristy L. Kummerow, MD, of Vanderbilt University Medical Center, is the corresponding author for the JAMA Surgery article.
This study is based on work supported by the Office of Academic Affiliations, Department of Veterans Affairs, Veterans Affairs National Quality Scholars Program.
The authors reported no conflicts of interest.
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