Socioeconomic Factors Associated with the Receipt of Contralateral Prophylactic Mastectomy in Women with Breast Cancer

Jerome-D’Emilia, Bonnie; Trinh, Hanh

doi:10.1089/jwh.2018.7350

Cited by 8 publications

(16 citation statements)

References 47 publications

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“…From 2011 to 2014, the CPM rate ranged from 34% to 69% of all mastectomy cases and from 12% to 28% of all breast cancer procedures. 38,39,42,43,45 Five articles [47][48][49][50][51] evaluated data from single-state cancer registries and demonstrated similar trends in CPM rates, with increases from approximately 2% of all breast cancer procedures in 1995 through 1998 to 10% to 12% in 2011 to 2014. Eleven articles [52][53][54][55][56][57][58][59][60][61][62] evaluated national trends in CPM.…”

Section: Procedures Use Ratesmentioning

confidence: 99%

“…Overall, studies were congruent in identifying factors associated with higher CPM rates across institutional, state, and national levels. Nearly every article [37][38][39][40][41][42][43][44][45][46]48,49,[51][52][53][54][55][57][58][59]61 identified younger age as a factor associated with CPM. Additional patient factors associated with CPM included white race, 37,39,[41][42][43]46,[48][49][50][51][52][53][54][55]57,59,61,62 increased socioeconomic status or private insurance, 39,[48][49][50][51][52]54,55,57,62 marital status, 38,…”

Section: Determinants Of Deimplementationmentioning

confidence: 99%

“…36,37,41,42,44,46 Patients with smaller, lower-grade tumors and decreased stage or node-negative disease were more likely to undergo CPM compared with those with unilateral mastectomy. 38,[40][41][42]48,52,57,59 Nine studies 38,39,46,49,53,57,59,61,62 found increased CPM rates in patients with lobular histology, although 3 studies 42-44 did not find any association between histology and CPM receipt. Chemotherapy receipt was associated with increased CPM rates.…”

Section: Determinants Of Deimplementationmentioning

confidence: 99%

“…Chemotherapy receipt was associated with increased CPM rates. 38,48,51 The outcome of tumor hormone status [39][40][41]44,46,49,55,59 and multifocal or multicentric disease on CPM rates were inconsistent across studies, with some 44,46 finding that these factors increased CPM rates while others 38,41 found that they decreased or had no association with CPM rates.…”

Section: Determinants Of Deimplementationmentioning

confidence: 99%

“…36,41,42,[44][45][46]51,54,55,60,62 Breast reconstruction was a also a factor significantly associated with CPM, and women who chose immediate breast reconstruction were more than twice as likely to undergo CPM than those who did not, regardless of any other patient-level or tumor-level factors. [36][37][38][39][41][42][43][44]46,48,52,53 Avoiding Routine Use of SLNB in Women 70 Years or Older Who Have Clinically Node-Negative Hormone Receptor-Positive Invasive Breast Cancer This recommendation was released in 2016 based on the Cancer and Leukemia Group B C9343 study. 67 Initial results in 2003 and updated results in 2013 demonstrated no difference in overall survival in women who received axillary evaluation compared with those who did not.…”

Section: Determinants Of Deimplementationmentioning

confidence: 99%

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Deimplementation of the Choosing Wisely Recommendations for Low-Value Breast Cancer Surgery

2020

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stage breast cancer results in increased morbidity and cost without improving survival. Major surgical organizations participating in the Choosing Wisely campaign identified 4 breast cancer operations as low value: (1) axillary lymph node dissection for limited nodal disease in patients receiving lumpectomy and radiation, (2) re-excision for close but negative lumpectomy margins for invasive cancer, (3) contralateral prophylactic mastectomy in patients at average risk with unilateral cancer, and (4) sentinel lymph node biopsy in women 70 years or older with hormone receptor-positive cancer.OBJECTIVE To evaluate the extent to which these procedures have been deimplemented, determine the implications of decreased use, and recognize possible barriers and facilitators to deimplementation.EVIDENCE REVIEW A systematic review of published literature on use trends in breast surgery was performed in accordance with PRISMA guidelines. The Ovid, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases were searched for original research with relevance to the Choosing Wisely recommendations of interest. Eligible studies were examined for data about use, and any patient-level, clinician-level, or system-level factors associated with use.FINDINGS Concordant with recommendations, national rates of axillary lymph node dissection for patients with limited nodal disease have decreased by approximately 50% (from 44% in 2011 to 30% to 34% in 2012 and 25% to 28% in 2013), and national rates of lumpectomy margin re-excision have decreased by nearly 40% (from 16% to 34% before to 14% to 18% after publication of a consensus statement). Conversely, national rates of contralateral prophylactic mastectomy continue to rise each year, accounting for up to 30% of all mastectomies for breast cancer (range in all mastectomy cases: 2010-2012, 28%-30%; 1998, <2%), and rates of sentinel lymph node biopsy in women 70 years or older with low-risk breast cancer are persistently greater than 80% (range, 80%-88%). Factors associated with high rates of contralateral prophylactic mastectomy use are younger age, white race, increased socioeconomic status, and the availability of breast reconstruction; limited data exist on factors associated with high rates of sentinel lymph node biopsy in women 70 years or older. Successful deimplementation of axillary lymph node dissection and lumpectomy margin re-excision were associated with decreased costs and improved patient-centered outcomes.CONCLUSIONS AND RELEVANCE This review demonstrates variable deimplementation of 4 low-value surgical procedures in patients with breast cancer. Addressing specific patient-level, clinician-level, and system-level barriers to deimplementation is necessary to encourage shared decision-making and reduce overtreatment.

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Section: Procedures Use Ratesmentioning

confidence: 99%

Section: Determinants Of Deimplementationmentioning

confidence: 99%

Section: Determinants Of Deimplementationmentioning

confidence: 99%

Section: Determinants Of Deimplementationmentioning

confidence: 99%

Section: Determinants Of Deimplementationmentioning

confidence: 99%

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Deimplementation of the Choosing Wisely Recommendations for Low-Value Breast Cancer Surgery

2020

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Impact of age, rurality and distance in predicting contralateral prophylactic mastectomy for breast cancer in a Midwestern state: a population-based study

Lizarraga

Kahl

Jacoby

et al. 2021

Breast Cancer Res Treat

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Background: There is substantial variability in the use of contralateral prophylactic mastectomy (CPM) in women with unilateral breast cancer across the United States. Iowa is one of several rural Midwestern states found to have the highest proportions of CPM nationally in women <45 years of age. We evaluated the role of rurality and travel distance as factors related to these surgical patterns. Methods: Women with unilateral breast cancer (2007-2017) were identi ed using Iowa Cancer Registry records. Patients and treating hospitals were classi ed as metro, nonmetro and rural based on Rural-Urban Continuum Codes. Differences in patient, tumor, and treatment characteristics and median travel distances (MTD) were compared. Characteristics associated with CPM were evaluated with multivariate logistic regression. Results: 22,158 women were identi ed: 57% metro, 26% nonmetro and 18% rural. The overall proportion of CPM in Iowa was consistently higher than in the national Surveillance, Epidemiology, and End Results (SEER18) throughout the interval from 2007-2015. Young rural women had the highest proportion of CPM (<40 years: 52%, 39% and 40% for rural, metro, nonmetro, respectively). Half of all rural women had surgery at metro hospitals; these women had the longest MTD (56 miles). Of all women treated at metro hospitals, rural women had the highest proportion with CPM (17% rural; vs 14% metro/nonmetro, p=0.007). On multivariate analysis, traveling ≥50 miles (ORs 1.48-2.34) or being rural regardless of travel distance was predictive of CPM (OR = 1.36). Other risk factors were young age (<40 years: OR=7.18, 95% CI: 5.89-8.76) and surgery at a metro hospital that offers reconstruction (OR=2.3, 95% CI: 1.70-3.21) and is not NCIdesignated (OR=2.19, 95% CI: 1.78-2.69). Conclusion: There is an unexpectedly high proportion of CPM use in young rural women in Iowa. Travel ≥50 miles and rural residence are independently associated with likelihood of CPM. Disparities in access to specialty care may underlie the desire for surgery that is perceived to minimize follow-up visits. Methods: Women with unilateral breast cancer (2007-2017) were identi ed using Iowa Cancer Registry records. Patients and treating hospitals were classi ed as metro, nonmetro and rural based on Rural-Urban Continuum Codes. Differences in patient, tumor, and treatment characteristics and median travel distances (MTD) were compared. Characteristics associated with CPM were evaluated with multivariate logistic regression. Results: 22,158 women were identi ed: 57% metro, 26% nonmetro and 18% rural. The overall proportion of CPM in Iowa was consistently higher than in the national Surveillance, Epidemiology, and End Results (SEER18) throughout the interval from 2007-2015. Young rural women had the highest proportion of CPM (< 40 years: 52%, 39% and 40% for rural, metro, nonmetro, respectively). Half of all rural women had surgery at metro hospitals; these women had the longest MTD (56 miles). Of all women treated at metro hospitals, rural women had the highest p...

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Effect of rurality and travel distance on contralateral prophylactic mastectomy for unilateral breast cancer

Wahlen

Lizarraga

Kahl³

et al. 2023

Cancer Causes Control

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Purpose Despite lack of survival benefit, demand for contralateral prophylactic mastectomy (CPM) to treat unilateral breast cancer remains high. High uptake of CPM has been demonstrated in Midwestern rural women. Greater travel distance for surgical treatment is associated with CPM. Our objective was to examine the relationship between rurality and travel distance to surgery with CPM. Methods Women diagnosed with stages I–III unilateral breast cancer between 2007 and 2017 were identified using the National Cancer Database. Logistic regression was used to model likelihood of CPM based on rurality, proximity to metropolitan centers, and travel distance. A multinomial logistic regression model compared factors associated with CPM with reconstruction versus other surgical options. Results Both rurality (OR 1.10, 95% CI 1.06–1.15 for non-metro/rural vs. metro) and travel distance (OR 1.37, 95% CI 1.33–1.41 for those who traveled 50 + miles vs. < 30 miles) were independently associated with CPM. For women who traveled 30 + miles, odds of receiving CPM were highest for non-metro/rural women (OR 1.33 for 30–49 miles, OR 1.57 for 50 + miles; reference: metro women traveling < 30 miles). Non-metro/rural women who received reconstruction were more likely to undergo CPM regardless of travel distance (ORs 1.11–1.21). Both metro and metro-adjacent women who received reconstruction were more likely to undergo CPM only if they traveled 30 + miles (ORs 1.24–1.30). Conclusion The impact of travel distance on likelihood of CPM varies by patient rurality and receipt of reconstruction. Further research is needed to understand how patient residence, travel burden, and geographic access to comprehensive cancer care services, including reconstruction, influence patient decisions regarding surgery.

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Socioeconomic Factors Associated with the Receipt of Contralateral Prophylactic Mastectomy in Women with Breast Cancer

Cited by 8 publications

References 47 publications

Deimplementation of the Choosing Wisely Recommendations for Low-Value Breast Cancer Surgery

Deimplementation of the Choosing Wisely Recommendations for Low-Value Breast Cancer Surgery

Impact of age, rurality and distance in predicting contralateral prophylactic mastectomy for breast cancer in a Midwestern state: a population-based study

Effect of rurality and travel distance on contralateral prophylactic mastectomy for unilateral breast cancer

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