Nav: Home

Surgery to remove unaffected breast in early breast cancer increases

March 29, 2017

ATLANTA - March 29, 2017 - The proportion of women in the United States undergoing surgery for early-stage breast cancer who have preventive mastectomy to remove the unaffected breast increased significantly in recent years, particularly among younger women, and varied substantially across states. A new study co-led by the American Cancer Society and published in JAMA Surgery finds nearly half of young breast cancer patients in five states undergoing the procedure.

The use of contralateral prophylactic mastectomies (CPMs) among patients with invasive unilateral breast cancer has increased substantially during the past decade in the United States, particularly for patients under than 45, despite the lack of evidence for survival benefit. The reasons for this increasing pattern are unclear but are thought to include the fear of developing a second breast cancer and the desire for breast symmetry following reconstructive surgery.

To find out more about this trend, investigators from the American Cancer Society, Emory University, Dana-Farber Cancer Institute, and Brigham and Women's Hospital did a retrospective cohort study of 1.2 million women ages 20 and older who had been diagnosed with invasive unilateral early-stage breast cancer and treated with surgery from January 1, 2004, through December 31, 2012, in 45 states and the District of Columbia using data compiled by the North American Association of Central Cancer Registries.

Between 2004 and 2012, the proportion of patients who underwent a CPM nationally increased from 3.6% to 10.4% among women 45 and older and from 10.5% to 33.3% in those 20-44 years old.

While the increase was evident in all states, the magnitude of the increase varied substantially depending on the state. For example, among women ages 20 to 44, the proportion of CPM among women with unilateral early stage breast cancer and treated with surgery in New Jersey increased from 14.9% in 2004-2006 to 24.8% in 2010-2012, while in Virginia, the proportion tripled, from 9.8% to 32.2%.

Most strikingly, the proportion early-stage breast cancer patients age 20 to 44 receiving CPM in 2010-2012 were over 42% in the contiguous states of Nebraska, Missouri, Colorado, Iowa, and South Dakota.

From 2004 to 2012, the proportion of reconstructive surgical procedures among the women 20 to 44 increased in many states; however, that rise did not correlate with the proportion of women who received a CPM.

"Interestingly, the highest proportions of young women undergoing reconstructive surgery among young women who had a CPM were geographically clustered in several Northeastern states (Massachusetts, Maine, New Jersey, Connecticut, New York, and Delaware) rather than in the Midwestern region where we observed the highest proportions of women who underwent a CPM," write the authors.

"Several previous studies in the United States have reported an increase in the use of MRI and high-risk genetic testing among patients with breast cancer, coinciding with the increase in the proportion of patients undergoing a CPM nationally," write the authors. "However, the use of MRI and high-risk genetic testing among women is unknown by state, and we were unable to assess their contributions to the state variation in the proportions of CPMs among women with breast cancer treated with surgery."

"Future studies should examine patient-, clinician-, and health system-level factors to provide additional insight into the reasons for temporal changes and regional variation in the receipt of a CPM," said Ahmedin Jemal, D.V.M., Ph.D., senior author and vice president of surveillance & health services research and the American Cancer Society. "In the meantime, however, surgeons and other health care professionals should educate their patients about the benefit, harm, and cost of a CPM to help patients make informed decisions about their treatments."
-end-
Article: State Variation in the Receipt of a Contralateral Prophylactic Mastectomy Among Women Who Received a Diagnosis of Invasive Unilateral Early-Stage Breast Cancer in the United States, 2004-2012 JAMA Surg. 2017;152(7):1-10. doi:10.1001/jamasurg.2017.0115 Published online March 29, 2017.

American Cancer Society

Related Breast Cancer Articles:

Does MRI plus mammography improve detection of new breast cancer after breast conservation therapy?
A new article published by JAMA Oncology compares outcomes for combined mammography and MRI or ultrasonography screenings for new breast cancers in women who have previously undergone breast conservation surgery and radiotherapy for breast cancer initially diagnosed at 50 or younger.
Blood test offers improved breast cancer detection tool to reduce use of breast biopsy
A Clinical Breast Cancer study demonstrates Videssa Breast can inform better next steps after abnormal mammogram results and potentially reduce biopsies up to 67 percent.
Surgery to remove unaffected breast in early breast cancer increases
The proportion of women in the United States undergoing surgery for early-stage breast cancer who have preventive mastectomy to remove the unaffected breast increased significantly in recent years, particularly among younger women, and varied substantially across states.
Breast cancer patients with dense breast tissue more likely to develop contralateral disease
Breast cancer patients with dense breast tissue have almost a two-fold increased risk of developing disease in the contralateral breast, according to new research from The University of Texas MD Anderson Cancer.
Some early breast cancer patients benefit more from breast conservation than from mastectomy
Breast conserving therapy (BCT) is better than mastectomy for patients with some types of early breast cancer, according to results from the largest study to date, presented at ECC2017.
One-third of breast cancer patients not getting appropriate breast imaging follow-up exam
An annual mammogram is recommended after treatment for breast cancer, but nearly one-third of women diagnosed with breast cancer aren't receiving this follow-up exam, according to new findings presented at the 2016 Annual Clinical Congress of the American College of Surgeons.
Low breast density worsens prognosis in breast cancer
Even though dense breast tissue is a risk factor for breast cancer, very low mammographic breast density is associated with a worse prognosis in breast cancer patients.
Is breast conserving therapy or mastectomy better for early breast cancer?
Young women with early breast cancer face a difficult choice about whether to opt for a mastectomy or breast conserving therapy (BCT).
Breast density and outcomes of supplemental breast cancer screening
In a study appearing in the April 26 issue of JAMA, Elizabeth A.
Full dose radiotherapy to whole breast may not be needed in early breast cancer
Five years after breast-conserving surgery, radiotherapy focused around the tumor bed is as good at preventing recurrence as irradiating the whole breast, with fewer side effects, researchers from the UK have found in the large IMPORT LOW trial.

Related Breast Cancer Reading:

Dear Friend: Letters of Encouragement, Humor, and Love for Women with Breast Cancer
by Gina L Mulligan (Author)

Chicken Soup for the Soul: Hope & Healing for Your Breast Cancer Journey: Surviving and Thriving During and After Your Diagnosis and Treatment
by Dr. Julie Silver (Author)

Dr. Susan Love's Breast Book (A Merloyd Lawrence Book)
by Susan M. Love (Author), Karen Lindsey (Contributor), Elizabeth Love (Contributor)

Heal Breast Cancer Naturally: 7 Essential Steps to Beating Breast Cancer
by Dr. Veronique Desaulniers (Author)

The Whole-Food Guide for Breast Cancer Survivors: A Nutritional Approach to Preventing Recurrence (The New Harbinger Whole-Body Healing Series)
by Edward Bauman MEd PhD (Author), Helayne Waldman MS EdD (Author), Donald I. Abrams MD (Foreword)

The Breast Cancer Survival Manual, Sixth Edition: A Step-by-Step Guide for Women with Newly Diagnosed Breast Cancer
by John Link M.D. (Author), James Waisman M.D. (Author), Nancy Link R.N. (Author)

Breast Cancer Smoothies: 100 Delicious, Research-Based Recipes for Prevention and Recovery
by Daniella Chace (Author)

Just Get Me Through This! - Revised and Updated: A Practical Guide to Coping with Breast Cancer
by Deborah A. Cohen (Author), Robert M. Gelfand M.D. (Author)

Chris Beat Cancer: A Comprehensive Plan for Healing Naturally
by Chris Wark (Author)

Best Science Podcasts 2018

We have hand picked the best science podcasts for 2018. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Circular
We're told if the economy is growing, and if we keep producing, that's a good thing. But at what cost? This hour, TED speakers explore circular systems that regenerate and re-use what we already have. Guests include economist Kate Raworth, environmental activist Tristram Stuart, landscape architect Kate Orff, entrepreneur David Katz, and graphic designer Jessi Arrington.
Now Playing: Science for the People

#504 The Art of Logic
How can mathematics help us have better arguments? This week we spend the hour with "The Art of Logic in an Illogical World" author, mathematician Eugenia Cheng, as she makes her case that the logic of mathematics can combine with emotional resonance to allow us to have better debates and arguments. Along the way we learn a lot about rigorous logic using arguments you're probably having every day, while also learning a lot about our own underlying beliefs and assumptions.