PURPOSE: Breast conserving therapy (BCT) and mastectomy offer equivalent survival for women with newly diagnosed breast cancer (BrCa). Despite this, many women eligible for BCT elect mastectomy. Herein, we identify factors associated with choosing ipsilateral mastectomy instead of BCT when mastectomy is not required. METHODS: Between July 2007 and June 2010, 520 women with BrCa were treated by a single surgeon who prospectively documented patient eligibility for BCT. For patients who did not require mastectomy (n=392), we evaluated associations between treatment choice and potential predictors using odds ratios (ORs) obtained from multivariable logistic regression models. P values≤0.0029 were significant after correction for multiple testing. RESULTS: Of 392 women eligible for BCT, 106 (27%) chose mastectomy and 286 (73%) chose BCT. Multivariate analysis found an increased likelihood of electing mastectomy over BCT for patients with no comorbidities (OR 5.4; P<0.001) and those with previous mastectomy (OR 23.2; P<0.001). MRI and biopsy findings were associated with treatment choice because patients who had a second-site biopsy positive for cancer in the same quadrant as the index tumor were more likely to elect mastectomy compared with patients with no additional MRI abnormalities (OR 4.3; P=0.0027). No association existed on multivariate analysis between choice of mastectomy and patient age, family history, or tumor stage. CONCLUSIONS: One in four eligible BCT patients chooses mastectomy. Factors independently associated with choosing mastectomy over BCT include findings of second-site biopsy, previous mastectomy, and absence of comorbidities but not primary tumor characteristics. Further study into a patient’s choice for mastectomy is warranted.
PURPOSE: Breast conserving therapy (BCT) and mastectomy offer equivalent survival for women with newly diagnosed breast cancer (BrCa). Despite this, many women eligible for BCT elect mastectomy. Herein, we identify factors associated with choosing ipsilateral mastectomy instead of BCT when mastectomy is not required. METHODS: Between July 2007 and June 2010, 520 women with BrCa were treated by a single surgeon who prospectively documented patient eligibility for BCT. For patients who did not require mastectomy (n=392), we evaluated associations between treatment choice and potential predictors using odds ratios (ORs) obtained from multivariable logistic regression models. P values≤0.0029 were significant after correction for multiple testing. RESULTS: Of 392 women eligible for BCT, 106 (27%) chose mastectomy and 286 (73%) chose BCT. Multivariate analysis found an increased likelihood of electing mastectomy over BCT for patients with no comorbidities (OR 5.4; P<0.001) and those with previous mastectomy (OR 23.2; P<0.001). MRI and biopsy findings were associated with treatment choice because patients who had a second-site biopsy positive for cancer in the same quadrant as the index tumor were more likely to elect mastectomy compared with patients with no additional MRI abnormalities (OR 4.3; P=0.0027). No association existed on multivariate analysis between choice of mastectomy and patient age, family history, or tumor stage. CONCLUSIONS: One in four eligible BCT patients chooses mastectomy. Factors independently associated with choosing mastectomy over BCT include findings of second-site biopsy, previous mastectomy, and absence of comorbidities but not primary tumor characteristics. Further study into a patient’s choice for mastectomy is warranted.
Authors: Mehra Golshan; Sibylle Loibl; Stephanie M Wong; Jens Bodo Houber; Joyce O'Shaughnessy; Hope S Rugo; Norman Wolmark; Mark D McKee; David Maag; Danielle M Sullivan; Otto Metzger-Filho; Gunter Von Minckwitz; Charles E Geyer; William M Sikov; Michael Untch Journal: JAMA Surg Date: 2020-03-18 Impact factor: 14.766
Authors: Rebekah H Conley; Ingrid M Meszoely; Jared A Weis; Thomas S Pheiffer; Lori R Arlinghaus; Thomas E Yankeelov; Michael I Miga Journal: Int J Comput Assist Radiol Surg Date: 2015-06-20 Impact factor: 2.924
Authors: Mehra Golshan; Constance T Cirrincione; William M Sikov; Donald A Berry; Sara Jasinski; Tracey F Weisberg; George Somlo; Clifford Hudis; Eric Winer; David W Ollila Journal: Ann Surg Date: 2015-09 Impact factor: 12.969
Authors: Herbert Cubasch; Maureen Joffe; Paul Ruff; Donald Dietz; Evan Rosenbaum; Nivashni Murugan; Ming Tsai Chih; Oluwatosin Ayeni; Caroline Dickens; Katherine Crew; Judith S Jacobson; Alfred Neugut Journal: PLoS One Date: 2017-08-10 Impact factor: 3.240