Which Eligible Breast Conservation Patients Choose Mastectomy in the Setting of Newly Diagnosed Breast Cancer?
Summary of "Which Eligible Breast Conservation Patients Choose Mastectomy in the Setting of Newly Diagnosed Breast Cancer?"
PURPOSE:
Breast conserving therapy (BCT) and mastectomy offer equivalent survival for women with newly diagnosed breast cancer (BrCa). Despite this, many women eligible for BCT elect mastectomy. Herein, we identify factors associated with choosing ipsilateral mastectomy instead of BCT when mastectomy is not required.
METHODS:
Between July 2007 and June 2010, 520 women with BrCa were treated by a single surgeon who prospectively documented patient eligibility for BCT. For patients who did not require mastectomy (n = 392), we evaluated associations between treatment choice and potential predictors using odds ratios (ORs) obtained from multivariable logistic regression models. P values ≤0.0029 were significant after correction for multiple testing.
RESULTS:
Of 392 women eligible for BCT, 106 (27%) chose mastectomy and 286 (73%) chose BCT. Multivariate analysis found an increased likelihood of electing mastectomy over BCT for patients with no comorbidities (OR 5.4; P < 0.001) and those with previous mastectomy (OR 23.2; P < 0.001). MRI and biopsy findings were associated with treatment choice because patients who had a second-site biopsy positive for cancer in the same quadrant as the index tumor were more likely to elect mastectomy compared with patients with no additional MRI abnormalities (OR 4.3; P = 0.0027). No association existed on multivariate analysis between choice of mastectomy and patient age, family history, or tumor stage.
CONCLUSIONS:
One in four eligible BCT patients chooses mastectomy. Factors independently associated with choosing mastectomy over BCT include findings of second-site biopsy, previous mastectomy, and absence of comorbidities but not primary tumor characteristics. Further study into a patient's choice for mastectomy is warranted.
Affiliation
Department of General Surgery, Mayo Clinic Florida, Jacksonville, USA.
Journal Details
This article was published in the following journal.
Name: Annals of surgical oncology
ISSN: 1534-4681
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21975859
- DOI: http://dx.doi.org/10.1245/s10434-011-2080-x
Medical and Biotech [MESH] Definitions
Mastectomy, Subcutaneous
Excision of breast tissue with preservation of overlying skin, nipple, and areola so that breast form may be reconstructed.
Mastectomy, Simple
Removal of only the breast tissue and nipple and a small portion of the overlying skin.
Mucin-1
Carbohydrate antigen elevated in patients with tumors of the breast, ovary, lung, and prostate as well as other disorders. The mucin is expressed normally by most glandular epithelia but shows particularly increased expression in the breast at lactation and in malignancy. It is thus an established serum marker for breast cancer.
Mastectomy, Radical
Removal of the breast, pectoral muscles, axillary lymph nodes, and associated skin and subcutaneous tissue.
Mastectomy, Segmental
Removal of only enough breast tissue to ensure that the margins of the resected surgical specimen are free of tumor.
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