Why do women get mastectomy? Results from a population-based study

Abstract

605 Background: Persistently high rates of mastectomy (M) use for breast cancer have motivated lingering concerns about over-treatment. Yet, little information exists about the etiology of current rates of M. Methods: 2,030 women with non- metastatic breast cancer diagnosed from August 2005 to May 2006 and reported to the LA County SEER registry were identified and mailed a survey shortly after receipt of surgical treatment. Latina and African American women were over-sampled. Survey data were merged to SEER data. We report results on a 50% respondent sample (n=736) which will be updated based on a final respondent sample of 1400 patients (projected response rate, 72%). Results: M was ultimately performed in 279 women (37.9%): 47.3% (n=132) received initial M based on surgeon recommendation and most (80.8%) reported a clinical contraindication to breast conserving surgery (BCS); 69 patients (24.7%) chose M despite a surgeon recommendation for BCS or no recommendation favoring either procedure; and 28.0% (n=78) received M after initial attempts at BCS. This latter group included 16 of 22 patients who attempted BCS in spite of a surgeon recommendation for M. The failure rate of BCS in patients thought to be candidates for the procedure was 12.6%. One quarter of patients who received an initial recommendation for M sought a second opinion, and 80.6% reported concordance in recommendation for M between their first and second surgeons. Conclusions: Receipt of M in this large population sample was the result of clinical contraindications to BCS and, to a lesser extent, patient preference. The infrequent discordance in surgical opinions about the need for M and infrequent conversion to M in patients selected for BCS suggest that surgeons have accepted BCS and recognize standard contraindications to the procedure. Initiatives to improve surgical treatment decision-making should focus on patient perspectives about risk and benefits of surgical options and clinicopathologic features predictive of the success of re-excision after initial attempt at BCS. [Table: see text] No significant financial relationships to disclose.