Prevention driving increase in mastectomies



The overall mastectomy rate rose 36% from 2005 to 2013, even though “the incidence of breast cancer overall remained stable,” according to the Agency for Healthcare Research and Quality (AHRQ).

The rate of bilateral mastectomies jumped 226% over that time period, going from 9.1 per 100,000 adult women in 2005 to 29.7 per 100,000 in 2013. The unilateral mastectomy rate, starting at 57.3 per 100,000 women in 2005, rose to 69.8 in 2009 and then fell to 60.6 in 2013, for an increase of 6% overall, the AHRQ reported.

The rate of bilateral mastectomies without any cancer diagnosis increased from 2.0 to 4.4 per 100,000 from 2005 to 2013, and the unilateral rate rose from 2.7 to 3.7 per 100,000, the report noted.

Both unilateral and bilateral mastectomies are increasingly performed as outpatient procedures. The rate done in hospital-based ambulatory surgery settings nearly doubled from 16.1 to 31 per 100,000 women, and the overall proportion performed in ambulatory settings reached 45% in 2013, the AHRQ said.

The analysis shows that “more women are opting for mastectomies, particularly preventive double mastectomies, and more of those surgeries are being done as outpatient procedures,” AHRQ Director Rick Kronick, Ph.D., said in a written statement. These “changing patterns of care for breast cancer [highlight] the need for further evidence about the effects of choices women are making on their health, well-being, and safety.”

The analysis of the State Inpatient Databases and the State Ambulatory Surgery and Services Databases involved data from 13 states that had cases in both databases and used coding that allowed identification of unilateral versus bilateral mastectomies. Those 13 states represent more than 25% of the U.S. population.

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