Sharp Rise in Mastectomy in Early-Stage Breast Cancer

The gist: Despite breast conservation surgery (lumpectomy) becoming “a standard of excellence” for breast cancer, more and more women with early-stage breast cancer are opting for more invasive surgeries like mastectomy, bilateral mastectomy, and breast reconstruction. This trend sticks out because many other kinds of surgery have become less invasive. Lumpectomy and mastectomy give the same survival outcomes for most women with early-stage breast cancer.

“A retrospective cohort study of more than 1.2 million women treated for early-stage breast cancer in the United States has confirmed rising trends in the proportion of patients who undergo mastectomy, bilateral mastectomy, and breast reconstruction rather than breast conservation surgery for which they are eligible. Findings were reported in JAMA Surgery by Kristy L. Kummerow, MD, of the division of surgical oncology and endocrine surgery, and colleagues at the Vanderbilt University Medical Center and Tennessee Valley Healthcare System, Nashville, Tennessee.

“Breast conservation surgery was endorsed by the National Institutes of Health Consensus Conference in 1990 after studies demonstrated equivalent outcomes with mastectomy in early-stage breast cancer, ‘and has become a standard of excellence in breast cancer care,’ noted the authors. Accredited breast centers in the United States are thus measured on performance of breast conservation surgery in more than 50% of women who are eligible.

“All participants in the study were treated at centers accredited by the American Cancer Society and the American College of Surgeons Commission on Cancer from January 1, 1998, to December 31, 2011, using the National Cancer Data Base. The study was designed to determine the proportion of women with early-stage breast cancer who underwent mastectomy. Secondary outcome measures included temporal trends in breast reconstruction and bilateral mastectomy for unilateral disease.”