Trends in Mastectomy Rates at the Mayo Clinic Rochester: Effect of Surgical Year and Preoperative Magnetic Resonance Imaging

Department of Laboratory Medicine & Pathology, Mayo Clinic - Rochester, Рочестер, Minnesota, United States
Journal of Clinical Oncology (Impact Factor: 18.43). 07/2009; 27(25):4082-8. DOI: 10.1200/JCO.2008.19.4225
Source: PubMed

ABSTRACT Recent changes have occurred in the presurgical planning for breast cancer, including the introduction of preoperative breast magnetic resonance imaging (MRI). We sought to analyze the trends in mastectomy rates and the relationship to preoperative MRI and surgical year at Mayo Clinic, Rochester, MN.
We identified 5,405 patients who underwent surgery between 1997 and 2006. Patients undergoing MRI were identified from a prospective database. Trends in mastectomy rate and the association of MRI with surgery type were analyzed. Multiple logistic regression was used to assess the effect of surgery year and MRI on surgery type, while adjusting for potential confounding variables.
Mastectomy rates differed significantly across time (P < .0001), and decreased from 45% in 1997% to 31% in 2003, followed by increasing rates for 2004 to 2006. The use of MRI increased from 10% in 2003% to 23% in 2006 (P < .0001). Patients with MRI were more likely to undergo mastectomy than those without MRI (54% v 36%; P < .0001). However, mastectomy rates increased from 2004 to 2006 predominantly among patients without MRI (29% in 2003% to 41% in 2006; P < .0001). In a multivariable model, both MRI (odds ratio [OR], 1.7; P < .0001) and surgical year (compared to 2003 OR: 1.4 for 2004, 1.8 for 2005, and 1.7 for 2006; P < .0001) were independent predictors of mastectomy.
After a steady decline, mastectomy rates have increased in recent years with both surgery year and MRI as significant predictors for type of surgery. Further studies are needed to evaluate the role of MRI and other factors influencing surgical planning.

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Available from: Matthew P Goetz, Apr 03, 2014
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    • "IBR after SSM has gained popularity and has been used in an increasing proportion of patients. In addition to the gaining popularity, the number of patients with an indication for mastectomy is increasing due to improved pre-operative staging with breast MRI [3] and the introduction of risk reducing surgery in patients with hereditary breast cancer. Breast reconstruction in combination with preservation of the whole skin envelope compared to the standard mastectomy has raised concerns about the oncological safety of the SSM in terms of local recurrence. "
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    ABSTRACT: The aim of this study was to evaluate the incidence of local recurrence after SSM with IBR and to determine whether complications lead to postponement of adjuvant therapy. Patients that underwent IBR after SSM between 2004 and 2011 were included. A total of 157 reconstruction procedures were performed in 147 patients for invasive breast cancer (n = 117) and ductal carcinoma in situ (n = 40). The median follow-up was 39 months [range 6-97]. Estimated 5-year local recurrence rate was 2.9% (95%CI 0.1-5.7). The median time to start adjuvant therapy was 27.5 days [range 19-92] in 18 patients with complications, and 23.5 days [range 8-54] in 46 patients without complications (p = 0.025). In our single-institution cohort, IBR after SSM carried an acceptable local recurrence rate. Complications caused a delay of adjuvant treatment but this was within guidelines and therefore not clinically relevant.
    Breast (Edinburgh, Scotland) 09/2013; 22(6). DOI:10.1016/j.breast.2013.08.002 · 2.58 Impact Factor
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    • "Despite randomized controlled trial (RCT) evidence suggesting survival equivalence between breast conserving surgery with radiation (BCSR) and mastectomy for woman with early-stage breast cancer (ESBC) [1] [2] [3] [4] [5] and a nearly 20- year-old guideline from the National Institutes of Health Consensus Development Conference recommending BCSR over mastectomy because it preserves the breast [6], mastectomy remains widely used [7] [8]. In fact, recent evidence suggests that mastectomy rates are increasing [7] [9]. In addition, higher-staged patients have been more likely to receive mastectomy [8] [10]. "
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    ABSTRACT: Despite a 20-year-old guideline from the National Institutes of Health (NIH) Consensus Development Conference recommending breast conserving surgery with radiation (BCSR) over mastectomy for woman with early-stage breast cancer (ESBC) because it preserves the breast, recent evidence shows mastectomy rates increasing and higher-staged ESBC patients are more likely to receive mastectomy. These observations suggest that some patients and their providers believe that mastectomy has advantages over BCSR and these advantages increase with stage. These beliefs may persist because the randomized controlled trials (RCTs) that served as the basis for the NIH guideline were populated mainly with lower-staged patients. Our objective is to assess the survival implications associated with mastectomy choice by patient alignment with the RCT populations. We used instrumental variable methods to estimate the relationship between surgery choice and survival for ESBC patients based on variation in local area surgery styles. We find results consistent with the RCTs for patients closely aligned to the RCT populations. However, for patients unlike those in the RCTs, our results suggest that higher mastectomy rates are associated with reduced survival. We are careful to interpret our estimates in terms of limitations of our estimation approach.
    08/2012; 2012(2090-1402):127854. DOI:10.1155/2012/127854
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    • "Likewise, a group at the Mayo Clinic Rochester examined trends in their treatment of breast cancer over a ten-year period (1997–2006). They found that the general trend for mastectomy decreased over the years from 1996 to 2003 but increased again from 2003 through 2006—a trend which occurred both in the group which had received MRI and the group which had not [24]. MRI use increased drastically from the years between 2003 and 2006 as well. "
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    ABSTRACT: The utilization of MRI in the workup of breast cancer has played a controversial role in the surgical treatment of this disease. With the higher resolution of breast tissue afforded, additional lesions are being identified that often warrant additional procedures, subsequently affecting the decision to proceed with breast conservation therapy versus mastectomy. In this paper, a literature review is presented to help illuminate some of the benefits and pitfalls of employing MRI as a diagnostic tool in the care of breast cancer, while additionally providing insight into the management alterations this imaging modality can engender. Though further research is required in a randomized prospective form to fully answer this question, evidence for and against its use continues to mount, especially for select patient groups.
    04/2011; 2011(2090-1402):428653. DOI:10.1155/2011/428653
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