Are mastectomy rates really increasing in the United States?

Elizabeth B. Habermann, Andrea Abbott, Helen M. Parsons, Beth A. Virnig, Waddah B. Al-Refaie, Todd M. Tuttle

Research output: Contribution to journalArticle

166 Citations (Scopus)

Abstract

Purpose: After the National Institutes of Health Consensus Statement in 1990, breast-conserving surgery (BCS) became more common while mastectomy rates decreased. However, several recently published single-institution studies have reported an increase in mastectomy rates in the past decade. We conducted a population-based study to evaluate national trends in the surgical treatment of breast cancer from 2000 through 2006. Patients and Methods: Using the Surveillance, Epidemiology, and End Results database, we conducted a retrospective cohort analysis of women undergoing surgical treatment for breast cancer. We evaluated variation in mastectomy rates by demographic and tumor factors and calculated differences in mastectomy rates across time. We utilized logistic regression to identify time trends and patient and tumor factors associated with mastectomy, testing for significance using two-sided methods. Results: We identified 233,754 patients diagnosed with ductal carcinoma in situ or stage I to III unilateral breast cancer from 2000 to 2006. The proportion of women treated with mastectomy decreased from 40.8% in 2000 to 37.0% in 2006 (P < .001). These patterns were maintained across patient and tumor factors. Although the unilateral mastectomy rate decreased during the study period, the contralateral prophylactic mastectomy rate increased. Women were less likely to receive mastectomy over time (odds ratio, 1.18 for 2000 v 2006; 95% CI, 1.14 to 1.23; P < .0001), after adjusting for patient and tumor factors. Conclusion: In contrast to single-institution studies, our population-based analysis found a decrease in unilateral mastectomy rates from 2000 to 2006 in the United States. Variations in referral patterns and patient selection are potential explanations for these differences between single institutions and national trends.

Original languageEnglish (US)
Pages (from-to)3437-3441
Number of pages5
JournalJournal of Clinical Oncology
Volume28
Issue number21
DOIs
StatePublished - Jul 20 2010
Externally publishedYes

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Mastectomy
Neoplasms
Breast Neoplasms
Carcinoma, Intraductal, Noninfiltrating
Segmental Mastectomy
National Institutes of Health (U.S.)
Patient Selection
Population
Epidemiology
Cohort Studies
Referral and Consultation
Logistic Models
Odds Ratio
Demography
Databases
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Habermann, E. B., Abbott, A., Parsons, H. M., Virnig, B. A., Al-Refaie, W. B., & Tuttle, T. M. (2010). Are mastectomy rates really increasing in the United States? Journal of Clinical Oncology, 28(21), 3437-3441. https://doi.org/10.1200/JCO.2009.27.6774

Are mastectomy rates really increasing in the United States? / Habermann, Elizabeth B.; Abbott, Andrea; Parsons, Helen M.; Virnig, Beth A.; Al-Refaie, Waddah B.; Tuttle, Todd M.

In: Journal of Clinical Oncology, Vol. 28, No. 21, 20.07.2010, p. 3437-3441.

Research output: Contribution to journalArticle

Habermann, EB, Abbott, A, Parsons, HM, Virnig, BA, Al-Refaie, WB & Tuttle, TM 2010, 'Are mastectomy rates really increasing in the United States?', Journal of Clinical Oncology, vol. 28, no. 21, pp. 3437-3441. https://doi.org/10.1200/JCO.2009.27.6774
Habermann EB, Abbott A, Parsons HM, Virnig BA, Al-Refaie WB, Tuttle TM. Are mastectomy rates really increasing in the United States? Journal of Clinical Oncology. 2010 Jul 20;28(21):3437-3441. https://doi.org/10.1200/JCO.2009.27.6774
Habermann, Elizabeth B. ; Abbott, Andrea ; Parsons, Helen M. ; Virnig, Beth A. ; Al-Refaie, Waddah B. ; Tuttle, Todd M. / Are mastectomy rates really increasing in the United States?. In: Journal of Clinical Oncology. 2010 ; Vol. 28, No. 21. pp. 3437-3441.
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abstract = "Purpose: After the National Institutes of Health Consensus Statement in 1990, breast-conserving surgery (BCS) became more common while mastectomy rates decreased. However, several recently published single-institution studies have reported an increase in mastectomy rates in the past decade. We conducted a population-based study to evaluate national trends in the surgical treatment of breast cancer from 2000 through 2006. Patients and Methods: Using the Surveillance, Epidemiology, and End Results database, we conducted a retrospective cohort analysis of women undergoing surgical treatment for breast cancer. We evaluated variation in mastectomy rates by demographic and tumor factors and calculated differences in mastectomy rates across time. We utilized logistic regression to identify time trends and patient and tumor factors associated with mastectomy, testing for significance using two-sided methods. Results: We identified 233,754 patients diagnosed with ductal carcinoma in situ or stage I to III unilateral breast cancer from 2000 to 2006. The proportion of women treated with mastectomy decreased from 40.8{\%} in 2000 to 37.0{\%} in 2006 (P < .001). These patterns were maintained across patient and tumor factors. Although the unilateral mastectomy rate decreased during the study period, the contralateral prophylactic mastectomy rate increased. Women were less likely to receive mastectomy over time (odds ratio, 1.18 for 2000 v 2006; 95{\%} CI, 1.14 to 1.23; P < .0001), after adjusting for patient and tumor factors. Conclusion: In contrast to single-institution studies, our population-based analysis found a decrease in unilateral mastectomy rates from 2000 to 2006 in the United States. Variations in referral patterns and patient selection are potential explanations for these differences between single institutions and national trends.",
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