More Breast Cancer Patients Choosing Mastectomy

Increased number of patients moving away from breast conservation surgery in early stages of disease.

A recent study finds that an increasing number of breast cancer patients are choosing to undergo mastectomy, including the removal of both breasts, instead of opting for breast conservation surgery (BCS), even in early stage disease confined to 1 breast.

In a study conducted by researchers from Vanderbilt University, it was also found that higher proportions of women opted for breast reconstruction over the past 10 years, with the rates of increase highest in women with lymph node-negative and in situ disease.

“Our findings of still-increasing rates of mastectomy, breast reconstruction, and bilateral mastectomy in women with early-stage breast cancer has implications for physician and patient decision making, as well as quality measurement,” said one of the study’s leads, Kristy Kummerow, MD, in a press release.

The researchers note that this trend is a reversal of what has occurred since the 1990s, when BCS was found to produce equivalent cancer outcomes.

The study examined records from more than 1.2 million women treated in the United States between 1998 and 2011, which showed that 35.5% of patients underwent mastectomy. The adjusted odds of mastectomy in women eligible for BCS jumped 34% during the final 8 years of the study period.

The rates of bilateral mastectomy for cancer in 1 breast went from 1.9% in 1998 to 11.2% in 2011. Meanwhile, breast reconstruction rates leaped from 11.6% in 1998 to 36.4% in 2011 in women undergoing a mastectomy.

The increasing mastectomy rates were highest among younger women with noninvasive disease, patients with smaller tumors, and patients with node-negative disease, which indicates the cancer is less likely to spread beyond the initial tumor, the study notes.

“This suggests that factors unrelated to disease burden or cancer control are influencing women, especially younger patients,” the authors wrote.

The cause of the trend toward breast reconstruction may be due to a number of factors, including the National Accreditation Program for Breast Centers expecting all women undergoing mastectomy be offered reconstruction, according to the study.

Additionally, the 1998 Women’s Health and Cancer Rights Act mandated insurance coverage for post-mastectomy reconstruction, which was found to significantly increase the rates of women insured by Medicare and Medicaid who received reconstructive procedures.