Breast cancer patients are deciding to undergo mastectomies, including removal of both breasts, instead of undergoing surgeries that could conserve their breasts even in cases of early detection of the disease. Those are the conclusions of a new study out of Vanderbilt University researchers which revealed the changing trends of the last decade regarding breast cancer.
The study led by Kristy Kummerow, M.D., and Mary Hooks, M.D., MBA, was published in the JAMA Surgery journal and demonstrated that among patients suffering from breast cancer, more women chose to have mastectomy or double mastectomy, which is clearly an inversion of the tendency since it had already been shown in studies preformed in the 1990’s that breast conservation surgery (BCS) and mastectomies produced equivalent cancer outcomes.
The researchers used information from the National Cancer Data Base, analyzing more than 1.2 million adult women, who were treated at centers accredited by the American Cancer Society and the American College of Surgeons Commission on Cancer between January, 1998 and December, 2011. Their conclusions revealed that 35.5 percent of the participants underwent mastectomies while the adjusted odds of mastectomy in BCS-eligible women increased 34 percent during the last eight years of the study. Additionally, the rates were particularly high among women with lymph node-negative and in situ (contained) disease.
The number of women who decided to have bilateral mastectomy increased from 1.9 to 11.2 percent between 1998 and 2011 and the general rates of mastectomy were more significant among younger women suffering from noninvasive disease with smaller tumors, node-negative disease, or less likely to spread beyond the initial tumor cancer. These results suggest that there are several unrelated factors influencing women’s decisions. Importantly, among women who were submitted to mastectomy, the number of cases of breast reconstruction increased from 11.6 to 36.4 percent.
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“Our findings of still-increasing rates of mastectomy, breast reconstruction and bilateral mastectomy in women with early-stage breast cancer has implications for physician and patient decision making, as well as quality measurement”, explained Dr. Kummerow in a press release.
The authors noted that the new trend regarding breast reconstruction is due to many factors. Since 1998, postmastectomy reconstruction procedures are covered by insurance, according to the Women’s Health and Cancer Rights Act, which has increased the number of breast cancer survivors that undergo the surgery. In addition, the National Accreditation Program for Breast Centers expects that all women are offered reconstruction, after being submitted to mastectomy.
The authors also believe that further studies are needed in order to improve the knowledge on patient, provider, policy and social factors, which are associated with these new trends.