Abstract
Introduction
Recent studies have reported increases in the rate of mastectomy and contralateral prophylactic mastectomy (CPM). We hypothesized that there would be different reasons for choosing mastectomy for women aged <50 compared with those aged ≥50 years.
Methods
A questionnaire was administered to 332 patients who underwent unilateral or bilateral mastectomy for breast cancer from 2006 to 2010. The survey queried on demographics, surgical choices, and rationale for those choices. A retrospective chart review was performed to determine tumor characteristics. Responses and clinical characteristics were described by contingency tables and compared using Fisher exact test or χ2 test, as appropriate.
Results
Of 332 patients surveyed, 310 were evaluable. Median age was 55 years, including 88 patients <50 (28 %) and 222 patients ≥50 (72 %) at time of diagnosis. Forty-four percent of women <50 and 41 % of women ≥50 were given the option of breast conservation and chose mastectomy (p > 0.63). The two groups did not differ in their reason for choosing mastectomy, with lower recurrence risk and improved survival cited as the two most common reasons. Younger patients were more likely to undergo reconstruction and CPM (p < 0.0001) as well as have estrogen receptor-negative tumors, undergo neoadjuvant chemotherapy, and have higher magnetic resonance imaging utilization (p < 0.05).
Conclusions
Choosing mastectomy and the reasons for doing so were the same for women aged <50 and ≥50 years. Prospective studies are needed to determine whether patient education regarding perceived versus actual recurrence risk and survival would alter this decision-making process.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
NIH Consensus conference. Treatment of early-stage breast cancer. JAMA. 1991;265:391–5.
Fisher B, Bauer M, Margolese R, et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med. 1985;312:665–73.
Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–41.
Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227–32.
Jacobson JA, Danforth DN, Cowan KH, et al. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med. 1995;332(14):907–11.
Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy. Cancer. 2003;98(4):697–702.
Arriagada RM, Lê MG, Guinebretière J.-M., et al. Late local recurrences in a randomised trial comparing conservative treatment with total mastectomy in early breast cancer patients. Ann Oncol. 2003;14(11):1617–22.
Tuttle TM, Habermann EB, Grund EH, et al. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;25(33):5203–09.
McGuire K, Santillan A, Kaur P, et al. Are mastectomies on the rise? A 13-year trend analysis of the selection of mastectomy versus breast conservation therapy in 5865 patients. Ann Surg Oncol. 2009;16(10):2682–90.
Arrington A, Jarosek S, Virnig B, et al. Patient and surgeon characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer. Ann Surg Oncol. 2009;16(10):2697–704.
King TA, Sakr R, Patil S, et al. Clinical management factors contribute to the decision for contralateral prophylactic mastectomy. J Clin Oncol. 2011;29(16):2158–64.
Tuttle TM, Jarosek S, Habermann EB, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol. 2009;27(9):1362–67.
Fancher TT, Palesty JA, Thomas R, et al. A woman’s influence to choose mastectomy as treatment for breast cancer. J Surg Res. 2009;153(1):128–31.
Hiotis K, Ye W, Sposto R, et al. Predictors of breast conservation therapy. Cancer. 2005;103(5):892–99.
Chagpar AB, Studts JL, Scoggins CR, et al. Factors associated with surgical options for breast carcinoma. Cancer. 2006;106(7):1462–66.
Chan A, Pintilie M, Vallis K, et al. Breast cancer in women < or = 35 years: review of 1002 cases from a single institution. Ann Oncol. 2000;11(10):1255–62.
Neff P, Bear H, Pierce C, et al. Long-term results of breast conservation therapy for breast cancer. Ann Surg. 1996;223:709–17.
Buckley J, Coopey S, Samphao S, et al. Recurrence rates and long-term survival in women diagnosed with breast cancer at age 40 and younger. Presented at 2011 breast cancer symposium; 2011.
Khan SA. Contralateral prophylactic mastectomy: what do we know and what do our patients know? J Clin Oncol. 2011;29(16):2132–35.
Disclosures
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fisher, C.S., Martin-Dunlap, T., Ruppel, M.B. et al. Fear of Recurrence and Perceived Survival Benefit are Primary Motivators for Choosing Mastectomy over Breast-Conservation Therapy Regardless of Age. Ann Surg Oncol 19, 3246–3250 (2012). https://doi.org/10.1245/s10434-012-2525-x
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-012-2525-x