Treatment Trends for Early-Stage Breast Cancer

December 5, 2014

Treatment Trends for Early-Stage Breast Cancer

  1. Henry Mark Kuerer, MD, PhD, FACS

Rates of mastectomy, bilateral mastectomy, and breast reconstruction are on the rise.

  1. Henry Mark Kuerer, MD, PhD, FACS

Clinicians in the U.S. who treat breast cancer patients note that women appear to be requesting mastectomy more often than breast-conserving surgery (BCS). To examine trends in the use of mastectomy and BCS, investigators used data from the National Cancer Data Base to conduct a retrospective cohort study of more than 1.2 million BCS-eligible women with early-stage disease (T0-2, N0-2, and M0) who were treated from 1998 through 2011.

Results were as follows:

  • A total of 35% of patients underwent mastectomy.

  • Mastectomy rates increased 34% between 2003 and 2011 (odds ratio in 2011 vs. 2003, 1.34; 95% confidence interval, 1.31–1.38).

  • In patients with in situ carcinoma, mastectomy rates increased 200% between 2003 and 2011 (odds ratio, 2.05; 95% CI, 1.95–2.15).

  • Bilateral mastectomy rates increased from 5.4% in 1998 to 29.7% in 2011.

  • Breast reconstruction rates increased from 11.6% in 1998 to 36.4% in 2011.

Comment

The authors conclude that the increases in mastectomy rates are primarily attributable to the increase in bilateral mastectomy for unilateral breast cancer. When patients request mastectomy, they often want to avoid radiotherapy and feel that bilateral mastectomy will allow for better breast symmetry. Marked improvements have also been made in surgical techniques during the same time periods with respect to skin and nipple-sparing mastectomy and reconstruction. Mastectomy versus BCS rates have been used as a quality measure for breast programs in the U.S. and Europe, and this measure has been losing favor among breast cancer experts as patient treatment trends change.

Editor Disclosures at Time of Publication

  • Disclosures for Henry Mark Kuerer, MD, PhD, FACS at time of publication Speaker's bureau Physicians’ Education Resource, LLC Grant / Research support Susan G. Komen Breast Cancer Foundation Editorial boards Annals of Surgical Oncology Leadership positions in professional societies Alliance for Clinical Trials in Oncology (Chair, Education Committee); Society of Surgical Oncology (Chair, Curriculum Ad Hoc Committee, Breast Program Directors

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Reader Comments (1)

SHERWYN WARREN Physician, Surgery, Specialized

Interesting trends. Patients want reassurance more than easy answers.

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