(RxWiki News) Women with breast cancer are often faced with a choice between partial or complete breast removal. More and more have been opting for the complete removal, new research suggests.
The authors of a new report, led by Kristy L. Kummerow, MD, of Vanderbilt University Medical Center in Nashville, reviewed data on more than 1.2 million women being treated for breast cancer.
The report found that higher proportions of women who qualify for breast conservation surgery were choosing mastectomies instead of less invasive breast conservation surgeries.
Breast conservation surgery is an operation to remove breast cancer but not the entire breast. It typically involves removal of a cancerous lump (lumpectomy) and some of the tissue surrounding the tumor. Mastectomy involves removing the breast.
“We hope our data will increase awareness of current trends and prompt efforts to better understand what is driving decisions for mastectomy in early breast cancer," Dr. Kummerow told dailyRx News.
"At the end of the day, the operation that a women undergoes for early breast cancer should be determined by that individual woman and her provider. That said, the onus is on us as healthcare providers to take the time to make sure patients are truly informed of the risks and benefits of available treatment options and able to make decisions that incorporate good information with an understanding of outcomes that matter most to them."
Dr. Kummerow added that more research is needed to understand factors that influence patients and providers with respect to surgical treatment of early breast cancer.
“We need to better understand the drivers of these decisions in order to develop tools for high-quality decision making,” she said.
Dr. Kummerow and team analyzed 14 years of data from the National Cancer Data Base. They found that the proportion of women with early-stage breast cancer who qualified for breast conservation surgery but chose mastectomy rose from 34.3 percent to 37.8 percent between 1998 and 2011.
The sharpest increase occurred in women who had cancer “in situ.” This is an early-stage cancer in which the tumor is still confined and has not spread to surrounding tissue or other organs in the body. Women with in situ tumors were 200 percent more likely to have a mastectomy in 2011 than they were in 2003.
The size of a tumor may be a deciding factor in choosing mastectomy over lumpectomy. Dr. Kummerow and colleagues found that younger women opted for mastectomy more often than breast conservation surgery — regardless of tumor size. Older women were more likely to choose mastectomy if the tumor was larger than 0.78 inches.
The authors also noted that reconstructive procedures in women undergoing mastectomy climbed from 36.9 percent to 57.2 percent between 1998 and 2011. Reconstructive procedures for mastectomy patients involve rebuilding the breast mound so that it is similar in size and shape to the breast before it was removed.
Also, the rate of bilateral mastectomy (removal of both breasts) for cancer in one breast went up from 1.9 percent in 2003 to 11.2 percent in 2011. Some women may choose to have the healthy breast removed due to fears of developing breast cancer in that breast, too. The Susan G. Komen Breast Cancer Foundation says, however, that the risk of getting cancer in the healthy breast is fairly low.
In an editorial, Bonnie Sun, MD, and Michael E. Zenilman, MD, of Johns Hopkins Medicine in Baltimore, wrote that this study “reveals a surprising rise in the rate of mastectomy for early-stage cancers.”
Drs. Sun and Zenilman write that "Existing guidelines are in place to ensure that patients are offered the appropriate options." They added that the study by Dr. Kummerow and team "should at least serve as a wake-up call that as we fulfill that responsibility, and use every type of care to give patients the best quality of life and survival advantage, the guidelines may need to change again."
The study and editorial were published online Nov. 19 in JAMA Surgery.
The study was based on research funded by the Office of Academic Affiliations, Department of Veterans Affairs and Veterans Affairs National Quality Scholars Program. The authors disclosed no conflicts of interest.
