A new study from Vanderbilt University revealed that more women with early-stage breast cancer are opting to have their breasts removed rather than undergoing breast-conserving procedures. The study, published in the Nov. 19 online JAMA Surgery, also found that a higher proportion of women are choosing to have breast reconstruction.
According to a Vanderbilt news release, this is a reversal of trends seen in the 1990s when breast conservation surgery – lumpectomies – was found to be as effective as mastectomies in early-stage cancer and was endorsed as a standard of excellence by a National Institutes of Health Consensus Conference.
For the study, researchers led by Kristy Kummerow, MD, a surgeon in the division of surgical oncology and endocrine surgery, Vanderbilt University Medical Center, Nashville, used the National Cancer Data Base and studied the records of 1.2 million women treated for early-stage breast cancer from 1998 to 2011. The data base captures about 70 percent of newly diagnosed cancers in the U.S.
The researchers found that the percentage of women who were eligible for lumpectomies but opted for breast removal increased from 34 percent in 1998 to 38 percent in 2011. The odds of choosing a mastectomy over breast conserving surgery rose by 34 percent between 2003 and 2011.
Breast reconstruction surgery grew from 12 percent in 1998 to 36 percent in 2011. In addition, rates of bi-lateral mastectomy – removal of both breasts – when only one breast was found to have cancer, increased from 2 percent in 1998 to nearly 11 percent in 2011.
“Our findings of still-increasing rates of mastectomy, breast reconstruction and bi-lateral mastectomy in women with early-stage breast cancer has implications for physicians and patient decision-making, as well as quality measurement,” said Kummerow in the news release.
The authors noted that their study could not determine the number of women who tested positive for mutations in the BRCA gene, which greatly increases the risk of developing breast cancer. Knowing this gene is present may influence a woman’s decision to have both breasts removed.
As for why there has been such a marked increase in mastectomies, one expert speculated it may be attributed to improvements in breast reconstruction and the mandate of the 1998 Women’s Health and Cancer Rights Act that requires insurance coverage of breast reconstruction following a mastectomy.
“One reason for the increased mastectomy rate may be because [breast] reconstruction options over the past two decades have continued to improve and there is greater awareness that reconstruction is covered by insurance,” Stephanie Bernik, MD, chief of surgical oncology at Lenox Hill Hospital in New York City, told HealthDay.
Other factors involving the choice of mastectomy noted the researchers, include doctor recommendations, patient concern about the cancer occurring in their second breast, use of breast MRIs, and a desire by the patient for breast symmetry.
Bernik, who was not involved in the study, called for more research into the reasons for increased mastectomies to be sure women are making informed decisions. “A woman’s choice to undergo a mastectomy with or without reconstruction is a legitimate one, as long as she is fully informed of the pros and cons of breast conservation versus removal of the breast,” she said.