Abstract
BackgroundSeveral recent studies have described increasing rates of unilateral and bilateral mastectomy among women with newly diagnosed breast cancer. The use of breast magnetic resonance imaging (MRI) has also risen rapidly, leading to speculation that the high false-positive rate and need for multiple biopsies associated with MRI may contribute to more mastectomies. The objective of this study was to determine whether newly diagnosed patients who underwent preoperative MRI were more likely to undergo mastectomy compared with those who did not have a preoperative MRI.MethodsA retrospective review was performed of all newly diagnosed patients with breast cancer at our academic breast center from 2004 to 2009.ResultsThe proportion of newly diagnosed patients with breast cancer having MRI prior to surgery increased from 6% in 2004 to 73% in 2009. Of 628 patients who underwent diagnostic MRI, 369 (59%) had abnormal results, 257 (41%) had one or more biopsies, and 73 had additional sites of cancer diagnosed. Patients with a malignant biopsy, or those with an abnormal MRI who did not undergo biopsy, had an increased mastectomy rate (P<0.01). However, patients with a normal MRI or a benign biopsy actually had a decreased mastectomy rate (P<0.05). Although there was a trend toward more bilateral mastectomies, the overall mastectomy rate did not change over this time period.ConclusionsAlthough there is a strong relationship between the result of an MRI and the choice of surgery, the overall effect is not always to increase the mastectomy rate. Some patients who were initially considering mastectomy chose lumpectomy after an MRI.
Highlights
Several recent studies have described increasing rates of unilateral and bilateral mastectomy among women with newly diagnosed breast cancer
Carefully conducted randomized controlled trials have shown no significant difference in either overall survival or local recurrence for women who undergo mastectomy versus those who elect to have breast conservation surgery (BCT) followed by radiation therapy for the treatment of early-stage breast cancer [1]
Breast magnetic resonance imaging (MRI) is often used in newly diagnosed patients with breast cancer to evaluate the extent of disease and look for additional foci of mammographically occult lesions in the affected breast, and to examine the contralateral breast
Summary
Several recent studies have described increasing rates of unilateral and bilateral mastectomy among women with newly diagnosed breast cancer. Conducted randomized controlled trials have shown no significant difference in either overall survival or local recurrence for women who undergo mastectomy versus those who elect to have breast conservation surgery (BCT) followed by radiation therapy for the treatment of early-stage breast cancer [1] Based on these findings, mastectomy rates had been declining over the past 3 decades in favor of BCT [2], but within the past several years both unilateral and bilateral mastectomy rates have begun to rise [3,4]. Based on the extent of disease and the location in the breast, patients may undergo wider lumpectomy or mastectomy; for the majority of patients in whom no additional lesions are found, management remains unchanged Whether or not this increased rate of detection of small foci of disease will lead to improvements in the local recurrence rate and/or mortality rate remains to be determined
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