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No Evidence of Mastectomy Overuse Found in Large Survey


 

More than three-quarters of women newly diagnosed with intraductal or stage I or II breast cancer elected breast-conserving surgery as their initial surgical therapy, according to a survey of nearly 2,000 women.

“For about the past 20 years, there have been concerns that mastectomy has been overutilized,” said Dr. Monica Morrow during a press briefing. “What we concluded from this study is that most surgeons in two large, diverse urban areas appropriately recommended surgical options for breast cancer treatment.”

The survey of 1,984 patients in Los Angeles and Detroit between June 2005 and February 2007 revealed that 66% of the women said their first surgeon recommended breast-conserving surgery (BCS). Only 17% reported that their surgeon recommended mastectomy, and another 17% reported that their surgeon did not recommend one procedure over the other, Dr. Morrow and her associates reported (JAMA 2009;302:1551–6).

“From a practical point of view, what these results imply is that if we are interested in decreasing the mastectomy rate, approaches which have been advocated—such as more extensive and expensive preoperative evaluations with additional imaging modalities, such as magnetic resonance imaging—are unlikely to have an impact on the mastectomy rate,” noted Dr. Morrow, the lead author of the study and a surgeon at Memorial Sloan-Kettering Cancer Center, New York.

The study, funded by the National Cancer Institute, involved women aged 20–79 years with newly diagnosed ductal carcinoma in situ or invasive breast cancer in stages I or II. Women were identified through reports to NCI's Surveillance, Epidemiology, and End Results (SEER) registries for the metropolitan areas of Los Angeles and Detroit. Investigators sent surveys to 3,133 women, and 2,290 returned the completed surveys for a response rate of 73%. Of the returned surveys, 306 were excluded.

Of the 341 patients whose surgeons recommended mastectomy, 67% reported that they had a contraindication to BCS.

Of the 19% of patients who sought a second opinion, differing recommendations were relatively uncommon. Only 20% of patients whose first surgeon recommended mastectomy received a recommendation for BCS from the second surgeon. Only 12% of patients whose first surgeon recommended BCS received a recommendation for mastectomy from the second surgeon, noted Dr. Morrow, who said she had no financial disclosures regarding the study.

The women tended to follow their surgeons' recommendations. Of the patients who did not get a second opinion, only 2.1% received mastectomy when their surgeon recommended BCS, and 89% of patients received mastectomy when their surgeon recommended it. Only 1.9% of patients received mastectomy when two surgeons recommended BCS, and 78% of patients received mastectomy when both surgeons recommended it.

Of patients who received BCS as initial therapy, 62% received no further surgery, 26% underwent reexcision only, 4% received reexcision followed by mastectomy, and 8% received mastectomy only.

Of the 19% of patients who sought a second opinion, differing recommendations were relatively uncommon.

Source DR. MORROW

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