Use of and Mortality After Bilateral Mastectomy Compared With Other Surgical Treatments for Breast Cancer in California, 1998–2011

Details

• Alternative Title:
  JAMA
• Personal Author:
  Kurian, Allison W. ; Lichtensztajn, Daphne Y. ; Keegan, Theresa H. M. ; Nelson, David O. ; Clarke, Christina A. ; Gomez, Scarlett L.
• Description:
  IMPORTANCE
  
  Bilateral mastectomy is increasingly used to treat unilateral breast cancer. Because it may have medical and psychosocial complications, a better understanding of its use and outcomes is essential to optimizing cancer care.
  
  OBJECTIVE
  
  To compare use of and mortality after bilateral mastectomy, breast-conserving therapy with radiation, and unilateral mastectomy.
  
  DESIGN, SETTING, AND PARTICIPANTS
  
  Observational cohort study within the population-based California Cancer Registry; participants were women diagnosed with stages 0–III unilateral breast cancer in California from 1998 through 2011, with median follow-up of 89.1 months.
  
  MAIN OUTCOMES AND MEASURES
  
  Factors associated with surgery use (from polytomous logistic regression); overall and breast cancer–specific mortality (from propensity score weighting and Cox proportional hazards analysis).
  
  RESULTS
  
  Among 189 734 patients, the rate of bilateral mastectomy increased from 2.0% (95% CI, 1.7%–2.2%) in 1998 to 12.3% (95% CI, 11.8%–12.9%) in 2011, an annual increase of 14.3% (95% CI, 13.1%–15.5%); among women younger than 40 years, the rate increased from 3.6% (95% CI, 2.3%–5.0%) in 1998 to 33% (95% CI, 29.8%–36.5%) in 2011. Bilateral mastectomy was more often used by non-Hispanic white women, those with private insurance, and those who received care at a National Cancer Institute (NCI)–designated cancer center (8.6% [95% CI, 8.1%–9.2%] among NCI cancer center patients vs 6.0% [95% CI, 5.9%–6.1%] among non-NCI cancer center patients; odds ratio [OR], 1.13 [95% CI, 1.04–1.22]); in contrast, unilateral mastectomy was more often used by racial/ethnic minorities (Filipina, 52.8% [95% CI, 51.6%–54.0%]; OR, 2.00 [95% CI, 1.90–2.11] and Hispanic, 45.6% [95% CI, 45.0%–46.2%]; OR, 1.16 [95% CI, 1.13–1.20] vs non-Hispanic white, 35.2% [95% CI, 34.9%–35.5%]) and those with public/Medicaid insurance (48.4% [95% CI, 47.8%–48.9%]; OR, 1.08 [95% CI, 1.05–1.11] vs private insurance, 36.6% [95% CI, 36.3%–36.8%]). Compared with breast-conserving surgery with radiation (10-year mortality, 16.8% [95% CI, 16.6%–17.1%]), unilateral mastectomy was associated with higher all-cause mortality (hazard ratio [HR], 1.35 [95% CI, 1.32–1.39]; 10-year mortality, 20.1% [95% CI, 19.9%–20.4%]). There was no significant mortality difference compared with bilateral mastectomy (HR, 1.02 [95% CI, 0.94–1.11]; 10-year mortality, 18.8% [95% CI, 18.6%–19.0%]). Propensity analysis showed similar results.
  
  CONCLUSIONS AND RELEVANCE
  
  Use of bilateral mastectomy increased significantly throughout California from 1998 through 2011 and was not associated with lower mortality than that achieved with breast-conserving surgery plus radiation. Unilateral mastectomy was associated with higher mortality than were the other 2 surgical options.
  
  
• Subjects:
  Adult Aged Article Breast Neoplasms Cohort Studies Elective Surgical Procedures Female Humans Mastectomy, Segmental Middle Aged Radiotherapy, Adjuvant Registries Risk

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• Source:
  JAMA. 312(9):902-914.
• Pubmed ID:
  25182099
• Pubmed Central ID:
  PMC5747359
• Document Type:
  Journal Article
• Funding:
  HHSN261201000034C/PHS HHS/United States ; HHSN261201000035C/PC,CA/None/None ; HHSN261201000140C/CA/NCI NIH HHS/United States ; HHSN261201000035C/PHS HHS/United States ; U58 DP000807/DP/NCCDPHP CDC HHS/United States ; 1U58 DP000807-01/DP/NCCDPHP CDC HHS/United States ; HHSN261201000035I/CA/NCI NIH HHS/United States ; HHSN261201000034C/CA/NCI NIH HHS/United States ; HHSN261201000140C/PHS HHS/United States ; P30 CA124435/CA/NCI NIH HHS/United States ; N01 PC035137/PC/NCI NIH HHS/United States
• Name as Subject:
  SEER Program
• Place as Subject:
  California
• Volume:
  312
• Issue:
  9
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:dd4580447be31155cd682de2c0083b623700ef3e2250ab4c4036129f14d1f621
• Download URL:
  https://stacks.cdc.gov/view/cdc/50654/cdc_50654_DS1.pdf
• File Type:
  [PDF - 438.09 KB ]