An Analysis of Immediate Postmastectomy Breast Reconstruction Frequency Using the Surveillance, Epidemiology, and End Results Database

Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
The Breast Journal (Impact Factor: 1.41). 05/2011; 17(4):352-8. DOI: 10.1111/j.1524-4741.2011.01105.x
Source: PubMed


Mastectomy is used to treat one third of the nearly 180,000 women diagnosed with breast cancer in the United States annually. In this study, we use population-level data from multiple years of the Surveillance, Epidemiology, End Results (SEER) database to further define patient, tumor, and geographic characteristics associated with immediate and early-delayed breast reconstruction. Population level de-identified data for the years 1998 to 2002 were extracted from the National Cancer Institute's (NCI) SEER cancer database. All female patients who were treated with mastectomy for a diagnosis of ductal and/or lobular breast cancer (including Paget disease) were included. The primary end point of interest was odds of reconstruction. Multivariate analysis was performed to control for patient demographic and oncologic characteristics. A total of 52,249 patients met the inclusion criteria. Reconstruction was performed in 8,446 patients (16.2%). Odds of reconstruction varied by region from 0.60 (Seattle) to 2.81 (Atlanta). African Americans were noted to have a significantly lower likelihood of reconstruction when compared with Caucasian patients (OR 0.60 versus 1.00). Patients living in nonmetropolitan regions were also significantly less likely to undergo reconstruction. Receipt of radiation therapy was also negatively correlated with likelihood of reconstruction. In this multicenter, multiyear analysis of factors associated with immediate or early-delayed reconstruction after mastectomy, we demonstrate that younger age, white race, metropolitan locale, and lower stage disease were all independently associated with higher likelihood of reconstruction. This information provides insight into breast reconstruction utilization and will help guide future studies to understand how these factors affect patient and physician decision-making.

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    • "We were able to study the association between reconstruction and the tumor factors separately, and none emerged as statistically significantly associated with reconstruction in the final multivariate model. This is in concordance with results of other studies, which have failed to find tumor size [44] [45] or ER-receptor status [31] [46] to be of significance for receiving reconstruction. We found women who had received radiotherapy less likely to receive reconstruction after mastectomy. "
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    ABSTRACT: We collected registry- and questionnaire-based data on socio-economic and health status, tumor- and treatment-related variables, and explored associations with receipt of reconstruction and information about treatment options in a nationwide cohort of Danish women, treated for primary breast cancer. A total of 594 women were available for analysis, 240 (40%) of these received reconstruction. Multivariate analyses showed that receipt of reconstruction was associated with 1) younger age at time of primary surgery (<36 years: OR = 10.04, [3.80-26.50], p < 0.001 and 36-49 years: OR = 2.48, [1.73-3.56], p < 0.001, compared to 50-60 year olds), 2) having received radiotherapy (OR = 0.57, [0.40-0.81], p = 0.002), 3) high income (Second quartile: OR = 1.74, [1.05-2.90], p = 0.033 and fourth quartile: OR = 2.18, [1.31-3.62], p = 0.003, compared with the lowest income quartile), and 4) ethnicity other than Danish (OR = 6.32, [1.58-25.36], p = 0.009). Health-related factors at the time of primary surgery (physical functioning, body mass index, smoking, use of alcohol, and comorbidity) were not associated with reconstruction. Odds of having received information about the option of reconstruction decreased by 8% per year of age in the multivariate analysis (OR = 0.92, [0.87-0.97], p = 0.003). In conclusion, younger age and not having been treated with radiotherapy was independently associated with reconstruction. In addition, higher income was also found to be associated with reconstruction despite free and equal access to reconstruction and healthcare in Denmark. Healthrelated factors were not associated with the use of reconstruction following mastectomy. Our findings underscore the need for physicians to ensure optimal level of information and accessibility to reconstruction for all women regardless of age, treatment, and socio-economic status. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Breast (Edinburgh, Scotland) 06/2015; DOI:10.1016/j.breast.2015.05.001 · 2.38 Impact Factor
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    • "Given the increased rates of postmastectomy breast reconstruction, we must also consider surveillance of the reconstructed breast cancer survivor. The literature shows that between 8 and 16 percent of breast cancer patients treated with mastectomy undergo postmastectomy reconstruction, and this number continues to increase [19–24]. Currently, there are no specific guidelines for postreconstructive surveillance of the ipsilateral breast [5, 10, 11]. "
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    ABSTRACT: We present the longest reported case of breast cancer recurrence, 52 years after initial diagnosis, in a patient initially treated with Halsted mastectomy. Observation and palpation of the chest wall resulted in late presentation, and this patient went on to demonstrate metastatic disease. Current surveillance guidelines lack specific recommendations regarding monitoring of the ipsilateral chest wall. In addition, the growing utilization of breast reconstruction poses an additional challenge to surveillance strategies of the ipsilateral breast. However, the emergence of MRI may present a new opportunity to identify ipsilateral recurrence. The changing landscape of breast cancer therapy warrants guidance from groups of national import such as ASCO, in the surveillance of breast cancer patients.
    Case Reports in Oncological Medicine 11/2011; 2011:107370. DOI:10.1155/2011/107370
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    ABSTRACT: Ethnic disparities exist in many areas of breast cancer treatment. When a mastectomy is necessary, the next discussion in the overall surgical management often focuses on breast reconstruction. This review will examine breast reconstruction trends within different ethnic groups and will briefly discuss underlying factors influencing current disparities. The literature available on differences in breast reconstruction loosely fits into two general categories: (1) the decision making process for reconstruction and (2) the receipt, timing and type of breast reconstruction. This review will seek to highlight several areas for possible intervention as well as areas where further research is needed.
    Cancer Treatment Reviews 02/2012; 38(5):362-7. DOI:10.1016/j.ctrv.2011.12.011 · 7.59 Impact Factor
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