Increasing Use of Elective Mastectomy and Contralateral Prophylactic Surgery Among Breast Conservation Candidates

Abstract

In this longitudinal registry study, major independent determinants of mastectomy for early-stage breast cancer include year of diagnosis, insurance status, and stage. Mastectomy rates declined until 2004, but have since increased in conjunction with immediate reconstruction and contralateral prophylactic mastectomy. Additional study is needed to identify the underlying reasons for and unintended consequences of the reemergence of radical surgery for early-stage breast cancer in the era of multidisciplinary care.

Factors Predictive of Treatment by Australian Breast Surgeons of Invasive Female Breast Cancer by Mastectomy rather than Breast Conserving Surgery

“…Notably BreastScreen Australia data have also indicated higher mastectomies rates for residents of more remote areas (Cancer Australia, 2012). Large tumour sizes of 40mm or more were also predictive of mastectomy in the present study which is consistent with the higher mastectomy rates seen for larger and more advanced tumours in other studies (Lazovich et al, 1997;Taylor et al, 1999;Dragun et al, 2012b;Zorzi et al, 2006).…”

“…This followed other studies that indicated the potential contribution of a wide range of person, provider and cancer characteristics to choosing mastectomy (Lazovich et al, 1997;Taylor et al, 1999;Zorzi et al, 2006;Dragun et al, 2012a;2012b). Variables analysed included: 1) Age at diagnosis (<30, 30-39, 40-49, 50-59, 60-69, 70-79, 80+ years).…”

“…Statement and reviews of evidence from randomized trials (Abrams et al, 1995;Fisher et al, 1995), mastectomy rates declined markedly in the U.S. (Lazovich et al, 1991;Lazovich et al, 1997;Habermann et al, 2010), Canada, (Gaudette et al, 2004) European countries, (Zorzi et al, 2006), although with a more recent upturn suggested in some North American localities (Tuttle et al, 2007;Katipamula et al, 2009;Dragun et al, 2012a;2012b). Australian data also showed a trend away from mastectomy towards breast conserving surgery both nationally and in a number of jurisdictions (Hill et al, 1990;1994;Byrne et al, 1993;South Australian Cancer Registry, 2000;Cuncins-Hearn et al, 2006;Kricker, 2011).…”

“…Studies in Australia and North America have reported higher rates in residents of more remote rural settings than city locations, in women treated by surgeons with low case loads, and for larger and more advanced breast cancers (Lazovich et al, 1991;Taylor et al, 1999;Dragun et al, 2012a;2012b). In North America, private health insurance has been linked to greater use of breast conserving surgery (Lazovich et al, 1991;Dragun et al, 2012a;2012b).…”

“…Studies in Australia and North America have reported higher rates in residents of more remote rural settings than city locations, in women treated by surgeons with low case loads, and for larger and more advanced breast cancers (Lazovich et al, 1991;Taylor et al, 1999;Dragun et al, 2012a;2012b). In North America, private health insurance has been linked to greater use of breast conserving surgery (Lazovich et al, 1991;Dragun et al, 2012a;2012b). In general, breast cancers detected through mammography screening in Australia have had lower mastectomy rates (Samnakay et al, 2005;Cancer Australia, 2012;Roder et al, 2012) with rates of around 28% applying in 1996-2005 and with lower rates applying to cancers detected at subsequent than initial screening rounds (Cancer Australia, 2012;Roder et al, 2012).…”