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

Published Date:

Aug 2017

Source:

Ann Surg. 266(2):353-360.

Language:

English

[PDF-592.84 KB]

Details:

Personal Authors:

Wapnir, Irene L. ; Kurian, Allison W. ; Lichtensztajn, Daphne Y. ; Clarke, Christina A. ; Gomez, Scarlett L. ;

Keywords:

[+]

Pubmed ID:

27611617

Pubmed Central ID:

PMC5629002

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.

Document Type:

Journal Article

Collection(s):

CDC Public Access

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

Main Document Checksum:

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Supporting Files:

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