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Mastectomies defy logic of survival rates

The Los Angeles Times

Evidence is mounting that many women with early-stage breast cancer are opting for mastectomies instead of having breast-conserving surgeries that offer the same odds of survival.

An analysis of more than 1.2 million breast cancer patients in the United States found that 37.8 percent of women who were eligible for breast-conserving surgery wound up getting mastectomies in 2011, the most recent year for which data were available. That’s up from 34.3 percent in 1998 — an increase large enough to be statistically significant, according to a report published Wednesday in JAMA Surgery.

Among the women who had mastectomies during the 14-year study period, 45 percent had total mastectomies, 34.7 percent had modified radical mastectomies, and 0.8 percent had radical mastectomies. But most of the overall increase in mastectomies could be traced to the 19.5 percent who opted for bilateral mastectomies. In 1998, these procedures accounted for only 5.4 percent of all mastectomies; by 2011, that figure had risen to 29.7 percent.

In a bilateral mastectomy, surgeons remove not only the breast with an early-stage tumor, but the tumor-free breast as well.

Long-term tracking of breast cancer patients has shown that women diagnosed with early-stage tumors fare just as well with the more limited breast-conserving surgery as they do with mastectomies. For instance, a study of California breast cancer patients published this year in JAMA found that the 10-year survival rate for women who had breast-conserving surgery (83.2 percent) was essentially the same as for women who chose bilateral mastectomy (81.2 percent) and slightly better than for women who had a single mastectomy (79.9 percent).

But most women don’t seem to realize that they can save their breasts without putting their health at risk, experts say. In the California study, the proportion of California women who picked bilateral mastectomy grew from 2 percent in 1998 to 12.3 percent in 2011, despite the favorable performance of breast-conserving surgery.

The authors of the new report, from Vanderbilt University in Nashville, say the reasons for bilateral mastectomy’s growing appeal “remain unclear,” but their data offer some hints. Among the 1.2 million women in their study, those who had any kind of mastectomy instead of breast-conserving surgery were more likely to have larger or more invasive tumors (though all of the cancers were at an early stage).


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