Mastectomy and Contralateral Prophylactic Mastectomy Rates: An Institutional Review

Abstract

Background. Breast conservation surgery (BCS) followed by radiation is as effective as mastectomy for long-term survival and is considered standard of care for early-stage breast cancer. An increasing number of patients are opting for cancer-side mastectomies (CM) and often contralateral prophylactic mastectomies (CPM). Our study investigates if there are increasing trends in our patient population toward CM and CPM and identifies common factors associated with those electing to have more extensive surgery. Methods. A retrospective analysis was performed on 812 breast cancer surgeries between January 2001 and December 2009 at The George Washington University Breast Care Center. BCS-eligible patients who elected to have BCS were compared with those who chose CM. Patients who underwent CM were compared with patients undergoing CM and CPM. Results. A personal or family history of breast cancer and larger tumor size were positively associated with choosing CM in BCS-eligible patients. A nonstatistically significant trend toward CM was seen in younger patients. Age, family history, fewer children, Caucasian race, and reconstructive surgery were positively associated with choosing CPM. Conclusion. Mastectomy rates at this institution have not shown the recent sharp increase observed by some authors. The association of age, race, family history, and parity with CPM has been corroborated in multiple studies. However, there is disagreement between statistically significant findings among investigators evaluating factors associated with CPM, and there is limited data in the literature characterizing BCS-eligible patients who chose CM. Larger prospective studies are necessary to further evaluate CM and CPM rates.In 1991, The National Institutes of Health issued a consensus statement advocating breast conservation surgery (BCS) as the preferred surgical treatment for earlystage breast cancer.1 Despite this long-standing recommendation, not all eligible patients receive this treatment. Furthermore, some institutions have noted an increasing trend in cancer-side mastectomy (CM) rates. In a 13-year institutional analysis of 5865 patients, McGuire and colleagues noted a rise in CM rates from 31% in 1997 to almost 60% in 2007. The authors cited possible reasons for this trend such as increased detection of additional foci, genetic testing, improved reconstruction techniques, and increased patient demand. Contralateral prophylactic mastectomy (CPM) reduces the risk of breast cancer by 91-96%.3,4 Although a significant improvement in survival has not been identified in most studies, a more recent study has demonstrated a modest survival benefit for women under 50. 5,6 Prophylactic mastectomy is usually reserved for patients who are at high risk for developing a contralateral breast cancer. The Society of Surgical Oncology's Position Statement on prophylactic mastectomy reports that CPM is potentially indicated in women at higher risk, such as those with BRCA1-2 gene mutations, atypical ductal hyperplasia, atypical lobular ...

Review of Factors Influencing Women's Choice of Mastectomy Versus Breast Conserving Therapy in Early Stage Breast Cancer: A Systematic Review

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Cost and Outcome Analysis of Breast Reconstruction Paradigm Shift

“…IntroductIon: Increasing use of bilateral mastectomies for treatment and prevention of breast cancer has generated an increased demand for bilateral breast reconstruction (1)(2)(3)(4). This study analyzes changing patterns of reconstructive methods aimed at meeting the combined goals of increased bilateral reconstruction and decreased morbidity.…”

Breast Tissue Expander—Related Infections: Perioperative Antimicrobial Regimens

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