Evolving Trends and Influencing Factors in Mastectomy Decisions

Abstract

It is known that survival is unaffected by the choice of surgical management for breast cancer (BC) patients. Despite this fact, recent literature reveals that the number of bilateral mastectomies (BMs) in the United States is increasing. In an effort to elucidate potential factors influencing this trend, we investigated socioeconomic and clinicopathologic characteristics of our patient cohort that could have affected a patient's decision between unilateral mastectomy (UM) versus BM. Five-hundred-eight patients with unilateral BC who underwent mastectomy between 2000 and 2009 were analyzed: 397-UM; 111-BM. Influence of patient's age, insurance status, residence (rural versus urban), subsequent reconstruction, marital status, smoking history, family cancer history, cancer stage and grade on the BM versus UM patient's decision were analyzed using independent sample t tests, χ2 and logistic regression analysis. BM was more likely to be chosen by younger (<50 years) patients (P < 0.001); patients with private insurance [odds ratio (OR) = 2.22, 95% confidence interval (CI) = 1.4–3.5]; residence in urban settings (OR = 5.09, 95% CI = 2.5–10.4); and plans for subsequent reconstruction (OR = 2.31, 95% CI = 1.4–3.8). Marital status, smoking history, family cancer history, BC stage and grade did not significantly impact patient's choice of BM versus UM. We found that patients with unilateral BC who are younger (<50 year) have private insurance, reside in urban settings, or plan for subsequent reconstruction are more likely to undergo BM for unilateral BC. Genetic specific data were not evaluated for this patient cohort, and will be the subject of future analysis.

Socioeconomic status significantly contributes to the likelihood of immediate postmastectomy breast reconstruction in the Netherlands: A nationwide study

“…This means that patients in the highest SES decile were 63.4% (95% CI; 60.4e66.8%) more likely to undergo IBR than patients in the lowest SES decile. This contributes to previous knowledge from studies which showed the effect of SES on the treatment of breast cancer [12,28,29]. The current study is also in line with a recent Swedish study which showed that age and SES contribute to the likelihood of receiving postmastectomy IBR [30].…”

Long-term Patient-Reported Outcomes in Postmastectomy Breast Reconstruction

“…The second study examined 2-year satisfaction with scores on the BREAST-Q survey, a validated patient-reported outcome instrument. 2 The authors found greater satisfaction and breast-related quality of life in patients who underwent au-Related articles pages 891 and 901…”

Contralateral Prophylactic Mastectomy in Women with Unilateral Breast Cancer Who Are Genetic Carriers, Have a Strong Family History or Are just Young at Presentation

“…The incidence of women with breast cancer who elect to undergo contralateral prophylactic mastectomy is steadily increasing, with preponderance amongst Caucasians, young women, and those with a higher socioeconomic status [1,2]. A study of 496,488 women with unilateral Stage I-III breast cancer, from the Surveillance, Epidemiology, End Results (SEER) Program database demonstrated an increase in contralateral prophylactic mastectomy rates performed for unilateral invasive breast cancer from 3.9% in 2002 to 12.7% in 2012 [3].…”

“…Factors that contribute to this decision include patient age, disease stage, previous breast biopsies, genetic predisposition or family history of breast cancer, fear of recurrence, concern with cosmetic symmetry and physician recommendation [1,[5][6][7][8].…”