Study evaluates bilateral mastectomy rates in early-stage breast cancer
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Since 2008, the rate of bilateral mastectomy among patients with early-stage breast cancer increased, decreased and finally stabilized with similar rates in 2020 as 2008, according to data published in JAMA Network Open.
“Studies have demonstrated increasing rates of bilateral mastectomy since the late 1990s,” Maria Fefferman, MD, a provider in the department of surgery at the University of Chicago, and colleagues wrote. “The first study reported increasing rates of bilateral mastectomy from 1998 to 2003 and subsequent studies examined rates up to 2007 and then 2011. A study showed increasing rates of bilateral mastectomy from 1998 to 2007.”
Fefferman and colleagues used the National Cancer Database to identify 988,666 adults (median age, 61 years) with stage 0 to II breast cancer from 2008 to 2020. They evaluated rates of bilateral mastectomy, unilateral mastectomy and breast-conserving surgery in the cohort. Exclusion criteria were neoadjuvant therapy, bilateral breast cancer and history of breast cancer.
Overall, 123,820 (12.5%) patients underwent bilateral mastectomy, 208,010 (21%) underwent unilateral mastectomy, and 656,836 (66.4%) underwent breast-conserving surgery.
The rate of bilateral mastectomy increased from 10.4% in 2008 to 15.6% in 2013, at which point it began to decrease until 2016. The rate stabilized and reached 11.3% in 2020, which was similar to the 2008 rate.
Rates of bilateral mastectomy decreased from 2013 in all age groups, but younger patients experienced a greater decrease compared with older patients (P < .001).
The rate of unilateral mastectomy decreased from 25% to 18.1%, and the rate of breast-conserving surgery decreased from 64.6% in 2008 to 61.7% in 2013, then increased to 70.7% in 2020.
The study was limited by lack of clinical information and medical history, as well as the data, which were not population-based, Fefferman and colleagues wrote.
“The decrease in bilateral mastectomy rates may reflect surgeon efforts based on the increasing number of publications on bilateral mastectomy trends,” they wrote. “We will continue to monitor bilateral mastectomy trends to determine the outcomes associated with the COVID-19 pandemic.”