Medical researchers in Nashville, Tennessee, have found that mastectomies may be increasing in women with breast cancer who could have other options. The study was reported in the November 19th issue of the Journal of the American Medical Association (JAMA) Surgery.
United States breast centers are evaluated positively based on the number of breast conservation surgeries that they perform compared to the number of mastectomies. There may be a current rise in the number of mastectomies performed in patients who are actually eligible for breast conservation surgery.
The purpose of the study was to see if mastectomy is increasing in women with early stage breast cancer — who could potentially undergo breast conservation surgery as a treatment. In breast conservation surgery, the surgeon removes the breast cancer but not the breast itself. It is also sometimes called “breast sparing surgery.”
Lead author Dr. Kristy Kummerow and her colleagues accessed publicly available information about breast surgeries in women with early stage breast cancer using the National Cancer Data Base, from January 1, 1998, to December 31, 2011. They studied over 1.2 million adult women treated at centers that had been accredited by the American Cancer Society and American College of Surgeons Commission on Cancer.
Of the women studied, 35.5% had a mastectomy, and the chance of having a mastectomy increased by 34% from 2003-2011. The greatest increases occurred in women with specific types of breast cancer, known as “node-negative and in situ disease.” They also found that in those women who had a mastectomy, breast reconstruction surgery rates increased from 11.6% in 1998 to 36.4% in 2011. There was also a rise in the removal of both breasts in women who only had cancer in one breast, which increased from 1.9% in 1998 to 11.2% in 2011.
In their article, the study authors stated “In the past decade, there have been marked trends toward higher proportions of BCS-eligible patients undergoing mastectomy, breast reconstruction, and bilateral mastectomy. The greatest increases are seen in women with node-negative and in situ disease. Further research is needed to understand factors associated with these trends and their implications.”
The reasons behind these increases in the rate of mastectomy are not yet clear, and more research is needed. Physician influence may play a role.
In their paper, the authors noted that “less than 50% of women reported being asked by their physicians whether they preferred BCS or mastectomy, and more than 80% of women reported that their physicians made a specific recommendation for either BCS or mastectomy. This suggests that physicians may strongly influence whether a woman with early-stage breast cancer undergoes BCS or mastectomy.”