Rising Bilateral Mastectomy Rates Among Neoadjuvant Chemotherapy Recipients in California, 1998–2012

Details

• Alternative Title:
  Ann Surg
• Personal Author:
  Wapnir, Irene L. ; Kurian, Allison W. ; Lichtensztajn, Daphne Y. ; Clarke, Christina A. ; Gomez, Scarlett L.
• Description:
  Background
  
  Neoadjuvant chemotherapy (NAC) for operable breast cancer (BC) can downstage disease and facilitate breast conservation.
  
  Objective
  
  To assess trends in NAC use and surgical procedures in California from 1/1/1998 to 12/31/2012 using statewide population-based cancer registry data.
  
  Methods
  
  236,797 women diagnosed with stage I–III BC were studied. Information regarding NAC, adjuvant chemotherapy (aCT), breast conserving surgery (BCS), bilateral mastectomy (BLM) and unilateral mastectomy (ULM) was abstracted from the medical records. Multivariable polytomous logistic regression were used to estimate odds ratios (OR) of receiving NAC and of type of surgery after NAC.
  
  Results
  
  40.1% (94,980) of patients received chemotherapy: 87% (82,588) aCT and 13.0% (12,392) NAC. NAC use more than doubled over time and increased with stage (Stage I, 0.7%; Stage III, 29.9%). Multivariable predictors of NAC treatment were stage (III), younger age (<40 years), Black or Hispanic race/ethnicity [versus non-Hispanic-white, OR 1.10, 95% confidence interval (CI) 1.05–1.16], and care at a National Cancer Institute (NCI)-designated center (OR 1.70, CI 1.58–1.82). Most (68.4%) NAC recipients had mastectomies, and 14.3% of them underwent BLM. In contrast, 47.9% aCT patients had mastectomies with 7.3% BLM. The only independent predictor of BCS after NAC was care at a NCI-designated center (OR 1.28, CI 1.10–1.49), and of BLM, age <40 (vs. 50–64, OR 2.59, CI 2.21–3.03), or residence in the highest socioeconomic neighborhood quintile (vs. lowest, OR 2.10, CI 1.67–2.64).
  
  Conclusion
  
  NAC use remains low. Predictors of surgery type after NAC were sociodemographic rather than clinical, raising concern for disparities in care access.
  
  
• Subjects:
  Adult Aged Article Breast Neoplasms California Chemotherapy, Adjuvant Female Humans Mastectomy Mastectomy, Segmental Middle Aged Neoadjuvant Therapy Neoplasm Staging Socioeconomic Factors

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• Source:
  Ann Surg. 266(2):353-360.
• Pubmed ID:
  27611617
• Pubmed Central ID:
  PMC5629002
• Document Type:
  Journal Article
• Funding:
  HHSN261201000140C/CA/NCI NIH HHS/United States ; HHSN261201000035C/CA/NCI NIH HHS/United States ; HHSN261201000036C/CA/NCI NIH HHS/United States ; U58 DP000807/DP/NCCDPHP CDC HHS/United States ; HHSN261201000035I/CA/NCI NIH HHS/United States ; HHSN261201000034C/CA/NCI NIH HHS/United States ; U01 CA197282/CA/NCI NIH HHS/United States
• Volume:
  266
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:9ed83d42eaaa8e3b0f44be0b75590f3c4516c2afe5f3c41dda44aec2bee37c57
• Download URL:
  https://stacks.cdc.gov/view/cdc/48961/cdc_48961_DS1.pdf
• File Type:
  [PDF - 592.84 KB ]