scholarly journals Impact of Age, Rurality and Distance in Predicting Contralateral Prophylactic Mastectomy for Breast Cancer in a Midwestern state: A Population-Based Study

2020 ◽  
Author(s):  
Ingrid Lizarraga ◽  
Amanda R Kahl ◽  
Ellie Jacoby ◽  
Mary E Charlton ◽  
Charles F Lynch ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Rural Women ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
The United States ◽  
Population Based ◽  
Travel Distance ◽  
Unilateral Breast Cancer

Abstract Background: There is substantial variability in the use of contralateral prophylactic mastectomy (CPM) in women with unilateral breast cancer across the United States. Iowa is one of several rural Midwestern states found to have the highest proportions of CPM nationally in women <45 years of age. We evaluated the role of rurality and travel distance as factors related to these surgical patterns.Methods: Women with unilateral breast cancer (2007-2017) were identified using Iowa Cancer Registry records. Patients and treating hospitals were classified as metro, nonmetro and rural based on Rural-Urban Continuum Codes. Differences in patient, tumor, and treatment characteristics and median travel distances (MTD) were compared. Characteristics associated with CPM were evaluated with multivariate logistic regression.Results: 22,158 women were identified: 57% metro, 26% nonmetro and 18% rural. The overall proportion of CPM in Iowa was consistently higher than in the national Surveillance, Epidemiology, and End Results (SEER18) throughout the interval from 2007-2015. Young rural women had the highest proportion of CPM (<40 years: 52%, 39% and 40% for rural, metro, nonmetro, respectively). Half of all rural women had surgery at metro hospitals; these women had the longest MTD (56 miles). Of all women treated at metro hospitals, rural women had the highest proportion with CPM (17% rural; vs 14% metro/nonmetro, p=0.007). On multivariate analysis, traveling ≥50 miles (ORs 1.48-2.34) or being rural regardless of travel distance was predictive of CPM (OR = 1.36). Other risk factors were young age (<40 years: OR=7.18, 95% CI: 5.89-8.76) and surgery at a metro hospital that offers reconstruction (OR=2.3, 95% CI: 1.70-3.21) and is not NCI-designated (OR=2.19, 95% CI: 1.78-2.69).Conclusion: There is an unexpectedly high proportion of CPM use in young rural women in Iowa. Travel ≥50 miles and rural residence are independently associated with likelihood of CPM. Disparities in access to specialty care may underlie the desire for surgery that is perceived to minimize follow-up visits.

Increasing Use of Contralateral Prophylactic Mastectomy for Breast Cancer Patients: A Trend Toward More Aggressive Surgical Treatment

2007 ◽  
Vol 25 (33) ◽  
pp. 5203-5209 ◽  
Author(s):  
Todd M. Tuttle ◽  
Elizabeth B. Habermann ◽  
Erin H. Grund ◽  
Todd J. Morris ◽  
Beth A. Virnig
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
The United States ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients ◽  
Unilateral Breast Cancer ◽  
Large Tumor ◽  
Decision Making Processes

Purpose Many patients with unilateral breast cancer choose contralateral prophylactic mastectomy to prevent cancer in the opposite breast. The purpose of our study was to determine the use and trends of contralateral prophylactic mastectomy in the United States. Patients and Methods We used the Surveillance, Epidemiology and End Results database to review the treatment of patients with unilateral breast cancer diagnosed from 1998 through 2003. We determined the rate of contralateral prophylactic mastectomy as a proportion of all surgically treated patients and as a proportion of all mastectomies. Results We identified 152,755 patients with stage I, II, or III breast cancer; 4,969 patients chose contralateral prophylactic mastectomy. The rate was 3.3% for all surgically treated patients; 7.7%, for patients undergoing mastectomy. The overall rate significantly increased from 1.8% in 1998 to 4.5% in 2003. Likewise, the contralateral prophylactic mastectomy rate for patients undergoing mastectomy significantly increased from 4.2% in 1998 to 11.0% in 2003. These increased rates applied to all cancer stages and continued to the end of our study period. Young patient age, non-Hispanic white race, lobular histology, and previous cancer diagnosis were associated with significantly higher rates. Large tumor size was associated with a higher overall rate, but with a lower rate for patients undergoing mastectomy. Conclusion The use of contralateral prophylactic mastectomy in the United States more than doubled within the recent 6-year period of our study. Prospective studies are needed to understand the decision-making processes that have led to more aggressive breast cancer surgery.

scholarly journals Contralateral Prophylactic Mastectomy in Women with Unilateral Breast Cancer Who Are Genetic Carriers, Have a Strong Family History or Are just Young at Presentation

Cancers ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 140 ◽  
Author(s):  
Victoria Teoh ◽  
Marios-Konstantinos Tasoulis ◽  
Gerald Gui
Keyword(s):  
Breast Cancer ◽  
Contralateral Breast Cancer ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Risk Groups ◽  
Genetic Mutation ◽  
Contralateral Breast ◽  
Strong Family History ◽  
Unilateral Breast Cancer

The uptake of contralateral prophylactic mastectomy is rising with increasing trends that are possibly highest in the USA. Whilst its role is generally accepted in carriers of recognized high-risk predisposition genes such as BRCA1 and BRCA2 when the affected individual is premenopausal, controversy surrounds the benefit in less understood risk-profile clinical scenarios. This comprehensive review explores the current evidence underpinning the role of contralateral prophylactic mastectomy and its impact on contralateral breast cancer risk and survival in three distinct at-risk groups affected by unilateral breast cancer: known genetic carriers, those with strong familial risk but no demonstrable genetic mutation and women who are of young age at presentation. The review supports the role of contralateral prophylactic mastectomy in “high risk” groups where the evidence suggests a reduction in contralateral breast cancer risk. However, this benefit is less evident in women who are just young at presentation or those who have strong family history but no demonstrable genetic mutation. A multidisciplinary and personalized approach to support individuals in a shared-decision making process is recommended.

The impact of breast reconstruction on the decision to undergo contralateral prophylactic mastectomy.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 96-96
Author(s):  
L. J. McGhan ◽  
B. A. Pockaj ◽  
R. J. Gray ◽  
S. P. Bagaria ◽  
S. A. McLaughlin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Breast Reconstruction ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Tumor Grade ◽  
Breast Cancer Patients ◽  
Unilateral Breast Cancer ◽  
The Impact ◽  
Implant Reconstruction

96 Background: In the last decade there has been an increase in the incidence of contralateral prophylactic mastectomy (CPM) for unilateral breast cancer. Although many factors have been proposed to explain this trend, the impact of breast reconstruction on the decision to undergo CPM has not been extensively studied. Methods: A retrospective review of breast cancer patients from Surveillance, Epidemiology and End Results (SEER) registry data (2004-2008) was conducted. Characteristics of patients undergoing CPM were evaluated. Results: 71,176 patients with a diagnosis of stage I-III infiltrating ductal or lobular breast cancer underwent mastectomy for their primary lesion. Among these, 10,558 patients (15%) underwent a CPM. A significantly higher proportion of women undergoing CPM had reconstruction performed (44%) than those patients not undergoing CPM (13%), p<0.001. On multivariate analysis (Table), significant variables predicting CPM included age <50 years (OR 10.12), breast reconstruction (OR 3.58), and lobular histology (OR 1.41), all p<0.001. Of the 12,466 patients (18%) who underwent reconstruction, 4,636 (37%) had implant reconstruction, 4,498 (36%) had tissue reconstruction, and 1,122 (9%) had combined tissue/implant reconstruction (no data for 18%). On multivariate analysis, predictors of reconstruction included age <50 years (OR 20.5; CI 18.5-22.7), year of surgery (2008 vs. 2004; OR 1.60; CI 1.49-1.71), low tumor grade (OR 1.19; CI 1.13-1.25) and ER+ status (OR 1.16; 95% CI 1.10-1.23). The use of radiation therapy was associated with a lower likelihood of pursuing reconstruction (OR 0.61; CI 0.58-0.65). Conclusions: Apart from age, the factor most strongly associated with CPM is the decision to have reconstructive surgery performed. This suggests that CPM may not be purely associated with risk-reduction but also with treatment factors such as cosmesis. [Table: see text]

Is less more? The association between hospital volume and low-value breast cancer surgeries.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 68-68
Author(s):  
Christina Ahn Minami ◽  
Ginger Jin ◽  
Tari A. King ◽  
Elizabeth A. Mittendorf
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Hospital Volume ◽  
Prophylactic Mastectomy ◽  
Survival Rates ◽  
Contralateral Prophylactic Mastectomy ◽  
Lymph Node Biopsy ◽  
Choosing Wisely ◽  
Axillary Lymph ◽  
Unilateral Breast Cancer

68 Background: Hospital volume is often equated with surgical quality. In breast surgical oncology, higher hospital volume has been associated with higher overall survival rates, but whether it is a proxy for quality with respect to low-value care remains unexplored. We thus examined the association between hospital volume and the use of three breast surgeries identified as low-value by the Choosing Wisely campaign. Methods: Patients with stage 0-III unilateral breast cancer diagnosed from 2013-2016 were identified in the National Cancer Database. The outcomes of interest were: 1) contralateral prophylactic mastectomy (CPM), 2) axillary lymph node dissection (ALND) for breast conserving therapy (BCT) patients with cT1-2N0 disease and <2 positive nodes, and 3) sentinel lymph node biopsy (SLNB) in women >70 years old with cT1N0 hormone receptor-positive (HR+) cancer. Multivariable regression models with restricted cubic splines were used to examine the association between annual hospital volume and outcomes of interest, after adjusting for patient-, disease-, and hospital-level risk factors. Results: Overall, 13.6% of 841,610 women with unilateral Stage I-III breast cancer underwent CPM, 9.2% of 832,205 BCT patients with clinical T1-T2N0 disease underwent ALND, and 85.7% of women >70 years of age with cT1N0 HR+ cancer underwent SLNB over the study period. In adjusted analyses that defined hospital volume by decile, patients treated in the first and tenth decile hospitals had lower odds of undergoing CPM as compared to those treated in the middle deciles (Table). BCT patients with cT1-2N0 disease treated in hospitals in the first and second decile had higher odds of undergoing an ALND than patients treated at higher volume hospitals. Hospital volume did not have an overall significant association with SLNB use in women >70 years old with cT1N0 HR+ disease. Conclusions: The relationship between hospital volume and performance of low-value breast surgeries differed for each Choosing Wisely recommendation, indicating that hospital volume is not a reliable proxy for quality with respect to low-value practices. Additional studies to identify practice-specific deimplementation strategies are needed. [Table: see text]

scholarly journals Cost-Effectiveness of Contralateral Prophylactic Mastectomy Versus Routine Surveillance in Patients With Unilateral Breast Cancer

2011 ◽  
Vol 29 (22) ◽  
pp. 2993-3000 ◽  
Author(s):  
Benjamin Zendejas ◽  
James P. Moriarty ◽  
Jamie O'Byrne ◽  
Amy C. Degnim ◽  
David R. Farley ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Cost Effective ◽  
Model Parameters ◽  
Average Risk ◽  
Unilateral Breast Cancer ◽  
Routine Surveillance ◽  
Life Years

Purpose Contralateral prophylactic mastectomy (CPM) rates in women with unilateral breast cancer are increasing despite controversy regarding survival advantage. Current scrutiny of the medical costs led us to evaluate the cost-effectiveness of CPM versus routine surveillance as an alternative contralateral breast cancer (CBC) risk management strategy. Methods Using a Markov model, we simulated patients with breast cancer from mastectomy to death. Model parameters were gathered from published literature or national databases. Base-case analysis focused on patients with average-risk breast cancer, 45 years of age at treatment. Outcomes were valued in quality-adjusted life-years (QALYs). Patients' age, risk level of breast cancer, and quality of life (QOL) were varied to assess their impact on results. Results Mean costs of treatment for women age 45 years are comparable: $36,594 for the CPM and $35,182 for surveillance. CPM provides 21.22 mean QALYs compared with 20.93 for surveillance, resulting in an incremental cost-effectiveness ratio (ICER) of $4,869/QALY gained for CPM. To prevent one CBC, six CPMs would be needed. CPM is no longer cost-effective for patients older than 70 years (ICER $62,750/QALY). For BRCA-positive patients, CPM is clearly cost-effective, providing more QALYs while being less costly. In non-BRCA patients, cost-effectiveness of CPM is highly dependent on assumptions regarding QOL for CPM versus surveillance strategy. Conclusion CPM is cost-effective compared with surveillance for patients with breast cancer who are younger than 70 years. Results are sensitive to BRCA-positive status and assumptions of QOL differences between CPM and surveillance patients. This highlights the importance of tailoring treatment for individual patients.

Factors associated with increasing rates of contralateral prophylactic mastectomy.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 57-57
Author(s):  
Danny Yakoub ◽  
Eli Avisar ◽  
Tulay Koru-Sengul ◽  
Feng Miao ◽  
Stacey L. Tannenbaum ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Census Data ◽  
Population Distribution ◽  
Prophylactic Mastectomy ◽  
Insurance Coverage ◽  
Healthcare Delivery ◽  
Contralateral Prophylactic Mastectomy ◽  
Population Based ◽  
Disease Stage ◽  
Outcome Variable

57 Background: Contralateral prophylactic mastectomy (CPM) is an option increasingly used by women who wish to reduce their risk of breast cancer or its local recurrence. There is limited data on demographic differences among patients who choose to undergo this procedure. Methods: The population-based Florida cancer registry, Florida’s Agency for Health Care Administration (AHCA) data, and U.S. census data were linked and queried for patients diagnosed with invasive breast cancer from 1996 to 2009. The main outcome variable was the rate of CPM in those with a single unilateral cancer diagnosis. Primary predictors were race, ethnicity, socioeconomic status (SES), marital status, and insurance status. Results: The rates of CPM rose from 2% in 1996 to 4.8% in 2006 up to 8% in 2009. The population studied was 91.1% white and 7.5% black; 89.1% non-Hispanic and 10.9% Hispanic. Out of 21,608 included patients, 837 (3.9%) underwent CPM. Significantly more white than black (3.9 versus 2.8%; p < 0.001) and more Hispanic than non-Hispanic (4.5 versus 3.8%; p = 0.0909) underwent CPM. Those in the highest SES category had higher rates of CPM compared to the lowest SES category (5.3 versus 2.9%; p < 0.001). In multivariate analyses, Blacks and uninsured patients had significantly less CPM compared to whites and private patients (OR = 0.59, 95% CI 0.42- 0.83, p = 0.002) and (OR = 0.60, 95% CI 0.36- 0.98, p = 0.043), respectively. Conclusions: CPM rates are significantly increasing; these rates were significantly different among patients of different race, socioeconomic class, and insurance coverage. This observation is not accounted for by population distribution, incidence or disease stage. More in-depth study of the causes of this increase and the disparities in healthcare delivery is critically needed.

Sign in / Sign up

Export Citation Format

Share Document