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Showing content from https://pubmed.ncbi.nlm.nih.gov/20548000/ below:

Are mastectomy rates really increasing in the United States?

Affiliations

• ¹ University of Minnesota andVeterans Affairs Medical Center, Minneapolis, MN, USA. ebh@umn.edu

• PMID: 20548000
• DOI: 10.1200/JCO.2009.27.6774

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Elizabeth B Habermann et al. J Clin Oncol. 2010.

• ¹ University of Minnesota andVeterans Affairs Medical Center, Minneapolis, MN, USA. ebh@umn.edu

• PMID: 20548000
• DOI: 10.1200/JCO.2009.27.6774

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Purpose: After the National Institutes of Health Consensus Statement in 1990, breast-conserving surgery (BCS) became more common while mastectomy rates decreased. However, several recently published single-institution studies have reported an increase in mastectomy rates in the past decade. We conducted a population-based study to evaluate national trends in the surgical treatment of breast cancer from 2000 through 2006.

Patients and methods: Using the Surveillance, Epidemiology, and End Results database, we conducted a retrospective cohort analysis of women undergoing surgical treatment for breast cancer. We evaluated variation in mastectomy rates by demographic and tumor factors and calculated differences in mastectomy rates across time. We utilized logistic regression to identify time trends and patient and tumor factors associated with mastectomy, testing for significance using two-sided methods.

Results: We identified 233,754 patients diagnosed with ductal carcinoma in situ or stage I to III unilateral breast cancer from 2000 to 2006. The proportion of women treated with mastectomy decreased from 40.8% in 2000 to 37.0% in 2006 (P < .001). These patterns were maintained across patient and tumor factors. Although the unilateral mastectomy rate decreased during the study period, the contralateral prophylactic mastectomy rate increased. Women were less likely to receive mastectomy over time (odds ratio, 1.18 for 2000 v 2006; 95% CI, 1.14 to 1.23; P < .0001), after adjusting for patient and tumor factors.

Conclusion: In contrast to single-institution studies, our population-based analysis found a decrease in unilateral mastectomy rates from 2000 to 2006 in the United States. Variations in referral patterns and patient selection are potential explanations for these differences between single institutions and national trends.

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• Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ.

  Tuttle TM, Jarosek S, Habermann EB, Arrington A, Abraham A, Morris TJ, Virnig BA. Tuttle TM, et al. J Clin Oncol. 2009 Mar 20;27(9):1362-7. doi: 10.1200/JCO.2008.20.1681. Epub 2009 Feb 17. J Clin Oncol. 2009. PMID: 19224844

• Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment.

  Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Tuttle TM, et al. J Clin Oncol. 2007 Nov 20;25(33):5203-9. doi: 10.1200/JCO.2007.12.3141. Epub 2007 Oct 22. J Clin Oncol. 2007. PMID: 17954711

• Patient and surgeon characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer.

  Arrington AK, Jarosek SL, Virnig BA, Habermann EB, Tuttle TM. Arrington AK, et al. Ann Surg Oncol. 2009 Oct;16(10):2697-704. doi: 10.1245/s10434-009-0641-z. Epub 2009 Aug 4. Ann Surg Oncol. 2009. PMID: 19653045

• Trends in the local treatment of breast cancer: should we be worried?

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