Bilateral mastectomy versus breast-conserving aurgery for early-atage breast cancer: The role of breast reconstruction Journal Article
| Authors: | Albornoz, C. R.; Matros, E.; Lee, C. N.; Hudis, C. A.; Pusic, A. L.; Elkin, E.; Bach, P. B.; Cordeiro, P. G.; Morrow, M. |
| Article Title: | Bilateral mastectomy versus breast-conserving aurgery for early-atage breast cancer: The role of breast reconstruction |
| Abstract: | Background: Although breast-conserving surgery is oncologically safe for women with early-stage breast cancer, mastectomy rates are increasing. The objective of this study was to examine the role of breast reconstruction in the surgical management of unilateral early-stage breast cancer. Methods: A retrospective cohort study of women diagnosed with unilateral early-stage breast cancer (1998 to 2011) identified in the National Cancer Data Base was conducted. Rates of breast-conserving surgery, unilateral and bilateral mastectomy with contralateral prophylactic procedures (per 1000 early-stage breast cancer cases) were measured in relation to breast reconstruction. The association between breast reconstruction and surgical treatment was evaluated using a multinomial logistic regression, controlling for patient and disease characteristics. Results: A total of 1,856,702 patients were included. Mastectomy rates decreased from 459 to 360 per 1000 from 1998 to 2005 (p < 0.01), increasing to 403 per 1000 in 2011 (p < 0.01). The mastectomy rates rise after 2005 reflects a 14 percent annual increase in contralateral prophylactic mastectomies (p < 0.01), as unilateral mastectomy rates did not change significantly. Each percentage point of increase in reconstruction rates was associated with a 7 percent increase in the probability of contralateral prophylactic mastectomies, with the greatest variation explained by young age(32 percent), breast reconstruction (29 percent), and stage 0 (5 percent). Conclusions: Since 2005, an increasing proportion of early-stage breast cancer patients have chosen mastectomy instead of breast-conserving surgery. This trend reflects a shift toward bilateral mastectomy with contralateral prophylactic procedures that may be facilitated by breast reconstruction availability. © 2015 by the American Society of Plastic Surgeons. |
| Keywords: | survival; treatment outcome; aged; disease-free survival; middle aged; survival analysis; retrospective studies; mortality; united states; comparative study; disease free survival; cancer staging; follow up; follow-up studies; neoplasm staging; mastectomy; pathology; breast neoplasms; breast reconstruction; mammaplasty; retrospective study; time; time factors; risk assessment; poisson distribution; cancer center; predictive value of tests; cancer care facilities; new york city; neoplasm invasiveness; factual database; databases, factual; carcinoma, intraductal, noninfiltrating; predictive value; segmental mastectomy; mastectomy, segmental; role playing; role; tumor invasion; procedures; mastectomy, radical; humans; human; female |
| Journal Title: | Plastic and Reconstructive Surgery |
| Volume: | 135 |
| Issue: | 6 |
| ISSN: | 0032-1052 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2015-06-01 |
| Start Page: | 1518 |
| End Page: | 1526 |
| Language: | English |
| DOI: | 10.1097/prs.0000000000001276 |
| PUBMED: | 26017588 |
| PROVIDER: | scopus |
| PMCID: | PMC4744797 |
| DOI/URL: | |
| Notes: | Export Date: 2 September 2015 -- Source: Scopus |
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