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


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 · 2.38 Impact Factor
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    • "Carefully conducted randomized controlled trials have shown no significant difference in either overall survival or local recurrence for women who undergo mastectomy versus those who elect to have breast conservation surgery (BCT) followed by radiation therapy for the treatment of early-stage breast cancer [1]. Based on these findings, mastectomy rates had been declining over the past 3 decades in favor of BCT [2], but within the past several years both unilateral and bilateral mastectomy rates have begun to rise [3,4]. Several reasons for this observed increase have been proposed, including expanded screening for carriers of BRCA1 and BRCA2 genetic mutations, advances in post-mastectomy breast reconstruction, increased public awareness and heightened patient anxiety, and the more liberal use of preoperative breast magnetic resonance imaging (MRI). "
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    ABSTRACT: Several recent studies have described increasing rates of unilateral and bilateral mastectomy among women with newly diagnosed breast cancer. The use of breast magnetic resonance imaging (MRI) has also risen rapidly, leading to speculation that the high false-positive rate and need for multiple biopsies associated with MRI may contribute to more mastectomies. The objective of this study was to determine whether newly diagnosed patients who underwent preoperative MRI were more likely to undergo mastectomy compared with those who did not have a preoperative MRI. A retrospective review was performed of all newly diagnosed patients with breast cancer at our academic breast center from 2004 to 2009. The proportion of newly diagnosed patients with breast cancer having MRI prior to surgery increased from 6% in 2004 to 73% in 2009. Of 628 patients who underwent diagnostic MRI, 369 (59%) had abnormal results, 257 (41%) had one or more biopsies, and 73 had additional sites of cancer diagnosed. Patients with a malignant biopsy, or those with an abnormal MRI who did not undergo biopsy, had an increased mastectomy rate (P<0.01). However, patients with a normal MRI or a benign biopsy actually had a decreased mastectomy rate (P<0.05). Although there was a trend toward more bilateral mastectomies, the overall mastectomy rate did not change over this time period. Although there is a strong relationship between the result of an MRI and the choice of surgery, the overall effect is not always to increase the mastectomy rate. Some patients who were initially considering mastectomy chose lumpectomy after an MRI.
    World Journal of Surgical Oncology 07/2013; 11(1):154. DOI:10.1186/1477-7819-11-154 · 1.41 Impact Factor
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    • "However, survey data from a cohort of 125 women undergoing surgical treatment of breast cancer, who were educated on mastectomy and BCT, showed that 35% opted for mastectomy even though they understood the benefits of BCT [14]. In the US, the percentage of patients undergoing mastectomy has risen in recent years [15]. This may be in part due to increased use of magnetic resonance imaging, which commonly identifies additional tumour foci in newly diagnosed patients, leading in some cases to a mastectomy that might not have been undertaken otherwise [16]. "
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    ABSTRACT: Background Currently about 70% of women who suffer from breast cancer undergo breast-conserving therapy (BCT) without removing the entire breast. Thus, this surgical approach is the standard therapy for primary breast cancer. If corrections are necessary, the breast surgeon is faced with irritated skin and higher risks of complications in wound healing. After radiation, an implant-based reconstruction is only recommended in selected cases. Correction of a poor BCT outcome is often only solved with an additional extended operation using autologous reconstruction. Material/Methods In our plastic surgery unit, which focuses on breast reconstruction, we offer a skin-sparing or subcutaneous mastectomy, followed by primary breast reconstruction based on free autologous tissue transfer to correct poor BCT outcomes. Between July 2004 and May 2011 we performed 1068 deep inferior epigastric artery perforator (DIEP) flaps for breast reconstruction, including 64 skin-sparing or subcutaneous mastectomies, followed by primary DIEP breast reconstruction procedures after BCT procedures. Results In all free flap-based breast reconstruction procedures, we had a total flap loss in 0.8% (9 cases). Within the group of patients after BCT, we performed 41 DIEP flaps and 23 ms-2 TRAM flaps after skin-sparing or subcutaneous mastectomies to reconstruct the breast. Among this group we had of a total flap loss in 1.6% (1 case). Conclusions In cases of large tumour sizes and/or difficult tumour locations, the initial oncologic breast surgeon should inform the patients of a possibly poor cosmetic result after BCT and radiation. In our opinion a skin-sparing mastectomy with primary breast reconstruction should be discussed as a valid alternative.
    Medical science monitor: international medical journal of experimental and clinical research 12/2012; 18(12):CR716-720. DOI:10.12659/MSM.883598 · 1.43 Impact Factor
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