共查询到20条相似文献,搜索用时 60 毫秒
1.
Damle S Teal CB Lenert JJ Marshall EC Pan Q McSwain AP 《Annals of surgical oncology》2011,18(5):1356-1363
Background
Breast conservation surgery (BCS) followed by radiation is as effective as mastectomy for long-term survival and is considered standard of care for early-stage breast cancer. An increasing number of patients are opting for cancer-side mastectomies (CM) and often contralateral prophylactic mastectomies (CPM). Our study investigates if there are increasing trends in our patient population toward CM and CPM and identifies common factors associated with those electing to have more extensive surgery.Methods
A retrospective analysis was performed on 812 breast cancer surgeries between January 2001 and December 2009 at The George Washington University Breast Care Center. BCS-eligible patients who elected to have BCS were compared with those who chose CM. Patients who underwent CM were compared with patients undergoing CM and CPM.Results
A personal or family history of breast cancer and larger tumor size were positively associated with choosing CM in BCS-eligible patients. A nonstatistically significant trend toward CM was seen in younger patients. Age, family history, fewer children, Caucasian race, and reconstructive surgery were positively associated with choosing CPM.Conclusion
Mastectomy rates at this institution have not shown the recent sharp increase observed by some authors. The association of age, race, family history, and parity with CPM has been corroborated in multiple studies. However, there is disagreement between statistically significant findings among investigators evaluating factors associated with CPM, and there is limited data in the literature characterizing BCS-eligible patients who chose CM. Larger prospective studies are necessary to further evaluate CM and CPM rates. 相似文献2.
Amanda Roberts MD MPH Mehran Habibi MD Kevin D. Frick PhD 《Annals of surgical oncology》2014,21(7):2209-2217
Background
A growing number of women with sporadic unilateral, early-stage breast cancers are undergoing ipsilateral therapeutic mastectomy with contralateral prophylactic mastectomy (CPM) to prevent the development of new cancers in the contralateral breast.Methods
A decision-tree using TreeAge Pro 2012 software was used to model the costs and effects of CPM versus unilateral mastectomy (UM) in women younger than 50 years of age with sporadic unilateral, early stage breast cancers. Cost estimates were obtained from the Medicare Fee Schedule and the Healthcare Utilization Project. Probability estimates were obtained from the literature. Outcome effects were measured by incremental cost per quality-adjusted life year (QALY) gained. A 10-year risk period for contralateral breast cancer (CBC), a lifetime time horizon, and a societal perspective were used.Results
Treatment with CPM results in 0.2 QALYs less than UM and $279 less in costs during a 10-year risk period and lifetime follow-up. The resulting incremental cost effectiveness ratio (ICER) is a savings of $1397 per QALY lost. The ICER is sensitive to the rate and method of postmastectomy reconstruction and the cost of radiologic surveillance after UM.Conclusions
CPM is cost-saving for the prevention of CBC in women younger than 50 years of age with sporadic, unilateral, early-stage breast cancers, but also reduces resulting health. The savings for health lost are insufficient to be considered cost-effective at this time. 相似文献3.
Melony E. S. Sorbero PhD MS MPH Andrew W. Dick PhD Ellen Burke Beckjord PhD MPH Gretchen Ahrendt MD FACS 《Annals of surgical oncology》2009,16(6):1597-1605
Background Preoperative use of breast magnetic resonance imaging (MRI) in women with breast cancer may increase rates of mastectomy.
This study investigated relationships between breast MRI and therapeutic and contralateral prophylactic mastectomy (CPM) in
women with breast cancer.
Methods A total of 3606 women diagnosed with stage 0–III breast cancer from 1998 through 2000 (n = 1743; early period) or from 2003 through 2005 (n = 1863; late period) were retrospectively identified. Patient demographic and clinical characteristics were obtained from
our institution’s tumor registry. MRI use in the diagnostic evaluation was obtained from a prospective radiology database.
Rates of therapeutic mastectomy, CPM, and associations with breast MRI were compared between the two time periods by multiple
logistic regressions controlling for disease stage, age, family history, and calendar year of diagnosis.
Results A total of 14.2% of women underwent MRI, 29.0% had mastectomy, and 5.3% had CPM. Use of breast MRI increased substantially
between the two time periods (4.1% to 23.7%, P < 0.001). Mastectomy rates increased from 28% to 30% (P > 0.05). The rate of CPM increased by >50% from the early to late period (4.1% to 6.4%, P < 0.002). Women who underwent MRI were nearly twice as likely to have CPM (9.2 vs. 4.7%, P < 0.001). Multivariate models found MRI was associated with increased rates of CPM for women with stage I or II disease (odds
ratio 2.04, P = 0.001).
Conclusions MRI changes the surgical treatment of breast cancer among subsets of women diagnosed with breast cancer, suggesting there
are hidden monetary and nonmonetary costs associated with its use. 相似文献
4.
5.
Gildy V. Babiera M.D. rew M. Lowy M.D. B. Scott Davidson M.D. S. Eva Singletary M.D. 《The breast journal》1997,3(1):2-6
Abstract: Invasive lobular carcinoma has been associated with an increased risk of contralateral breast disease. Controversy exists regarding the use of contralateral prophylactic mastectomy versus careful observation of the contralateral breast. Our objective was to determine the incidence of occult cancer in the contralateral breast and to assess whether contralateral prophylactic mastectomy improves patient survival. We retrospectively reviewed the charts of 133 patients treated surgically for invasive lobular carcinoma between January 1, 1978, and December 31, 1993. The median age was 54 years (range, 24–82 years). The distribution of patients by stage was as follows: stage 1, 29%; stage IIa, 36%; stage IIb, 20%; stage IIIa, 11%; stage IIIb, 3%; and unknown, 1%. The median follow-up was 68 months (range, 13–178 months). Group comparisons were performed using log-rank analysis and survival curves were constructed by the method of Kaplan and Meier. Eighteen patients underwent contralateral prophylactic mastectomy. Among these patients there were no cases of invasive cancer and only 3 (17%) cases of lobular carcinoma in situ in the contralateral breast. Three patients who underwent contralateral prophylactic mastectomy later developed distant metastases from the original ipsilateral breast cancer. Of the 115 patients managed conservatively, 3 (3%) developed contralateral disease at 11, 34, and 101 months. Twenty-five patients developed distant disease. Overall survival in the contralateral prophylactic mastectomy group did not differ significantly from the group treated conservatively (p = 0.90). We conclude that careful observation with a yearly mammogram and physical examination of the contralateral breast is appropriate management for patients with invasive lobular carcinoma. 相似文献
6.
Starr Koslow MD Lindsay A. Pharmer MD Amie M. Scott MPH Michelle Stempel MPH Monica Morrow MD Andrea L. Pusic MD MHS Tari A. King MD 《Annals of surgical oncology》2013,20(11):3422-3429
Purpose
To determine whether satisfaction and health-related quality of life (HR-QoL) differ between women who do and do not undergo contralateral prophylactic mastectomy (CPM) in the setting of implant reconstruction using the BREAST-Q, a validated patient-reported outcome instrument.Methods
From 2000 to 2007, a total of 3,874 patients with stage 0 to III unilateral breast cancer (BC) had mastectomy; 688 (18 %) pursued CPM within 1 year. Patients who completed the BREAST-Q reconstruction module as part of BREAST-Q validation studies or routine clinical care formed our study cohort. Comparisons were made between CPM and no-CPM patients using univariate analysis and multivariate models (MVA).Results
Of 294 patients with BREAST-Q data, 112 (38 %) had CPM. Median time from mastectomy to BREAST-Q was 52 months. CPM patients were younger (mean 47 vs. 50 years), more likely to be White (98 vs. 86 %), married (84 vs. 71 %), have a family history of BC (60 vs. 44 %), and to choose silicone implants (67 vs. 48 %). There were no differences in tumor or treatment characteristics between groups at the time of BREAST-Q. Patients with CPM had a higher mean score for Satisfaction with Breasts (64.4 vs. 54.9; p < 0.001) and Satisfaction with Outcome (74.8 vs. 67.7; p = 0.007); other HR-QoL domains did not differ. On MVA, CPM and the absence of lymphedema were significant predictors of Satisfaction with Breasts (CPM p = 0.005, lymphedema p = 0.039). CPM was not associated with improved Satisfaction with Outcome.Conclusions
This study suggests that in the setting of implant reconstruction, CPM has a positive correlation with patient satisfaction with their breasts, but not with improvements in other HR-QoL domains. 相似文献7.
Chang Xia MD PhD Mary C. Schroeder PhD Ronald J. Weigel MD PhD Sonia L. Sugg MD Alexandra Thomas MD 《Annals of surgical oncology》2014,21(13):4133-4138
Background
Women with breast cancer increasingly undergo contralateral prophylactic mastectomy (CPM). We evaluated the relationship between preoperative magnetic resonance imaging (MRI) findings and CPM. Other clinicopathologic variables associated with CPM choice and the pathology found in the contralateral breast are also reported.Methods
Newly diagnosed breast cancer patients were prospectively enrolled in the University of Iowa Breast Molecular Epidemiology Resource. Patients with stages 0–III breast cancer who underwent mastectomy for the index cancer were eligible for this analysis. Univariate logistic regression and a multivariate model were used to identify factors predictive of CPM.Results
Among 134 patients (mean age 54.9 years), 53 (39.6 %) chose CPM. On univariate analysis, patients undergoing CPM were more likely to have a preoperative breast MRI (64.2 vs. 39.5 %, p = 0.006) and to have follow-up testing recommended for the contralateral breast (28.3 vs. 4.9 %, p = 0.001). Univariate analysis also associated CPM with younger age (p < 0.0001), BRCA testing (p < 0.0001), BRCA mutation (p = 0.034) and reconstruction performed (p = 0.001). Median age of youngest child at diagnosis varied significantly between the CPM (15.9 years) and non-CPM (24.3 years) groups (p = 0.0018). On multivariate analysis, MRI follow-up recommendation, young age, reconstruction and human epidermal growth factor receptor 2 (HER2) positivity of the index cancer were significantly associated with CPM. Of the CPM specimens, one (1.8 %) had ductal carcinoma-in situ, which had not been identified on MRI.Conclusions
Abnormal findings in the contralateral breast on preoperative MRI, as well as young age, reconstruction and HER2-positive status correlated with CPM choice in this cohort. Occult malignancy was rare. 相似文献8.
Laura Kruper MD MSCE Rondi M. Kauffmann MD MPH David D. Smith PhD Rebecca A. Nelson PhD 《Annals of surgical oncology》2014,21(11):3448-3456
Background
Rates of contralateral prophylactic mastectomy (CPM) in women with breast cancer have increased, but most studies fail to show a survival benefit. We evaluated survival among CPM patients compared to patients undergoing single mastectomy (SM).Methods
The Surveillance, Epidemiology, and End Results database was used to identify unilateral breast cancer patients who underwent mastectomy with/without CPM from 1998 to 2010. Case-control analysis was performed with CPM cases matched to SM controls on the basis of age group, race/ethnicity, extent of surgery, grade, T classification, N classification, estrogen receptor status, and propensity score. Survival analyses included Kaplan–Meier curves and univariate and multivariate proportional hazard models to determine factors associated with disease-specific (DSS) and overall survival (OS).Results
A total of 26,526 CPM patients were identified. On multivariate regression analysis, increasing age, greater extent of surgery, increasing T and N stage, African American race, Hispanic ethnicity, poorly differentiated grade, and estrogen receptor negativity were associated with increased risk of death. CPM was associated with improved DSS (HR 0.86, 95 % CI 0.79–0.93) and even greater OS (HR 0.76, 95 % CI 0.71–0.81) compared with SM. Contralateral breast cancer (CBC) occurred in 1.6 % of women in the cohort. Removing CBC cases from analysis had little impact on CPM DSS (HR 0.86, 95 % CI 0.79–0.93) and OS (0.77, 95 % CI 0.72–0.82) suggesting that prevention of CBC by CPM does not explain the observed survival benefit.Conclusions
CPM rates continue to rise. The improved DSS and OS observed with CPM support selection bias. Prospective trials are needed to determine cohorts of patients most likely to benefit from CPM. 相似文献9.
Awais Ashfaq MD Lee J. McGhan MD Barbara A. Pockaj MD FACS Richard J. Gray MD FACS Sanjay P. Bagaria MD Sarah A. McLaughlin MD FACS William J. Casey III MD Alanna M. Rebecca MD Peter Kreymerman MD FACS Nabil Wasif MD FACS 《Annals of surgical oncology》2014,21(9):2934-2940
Background
In the last decade, there has been increasing use of contralateral prophylactic mastectomy (CPM) in patients with unilateral breast cancer and ductal carcinoma-in-situ (DCIS) undergoing mastectomy. Although many factors have been proposed to explain this trend, the impact of breast reconstruction on CPM has not been studied.Methods
A retrospective review of patients with unilateral invasive breast cancer or DCIS from Surveillance, Epidemiology, and End Results registry data (2004–2008) was conducted. Characteristics of patients undergoing CPM and reconstruction were evaluated.Results
A total of 102,674 patients diagnosed with DCIS or stage I to III infiltrating breast cancer underwent mastectomy for their primary lesion. Of these, 16,197 patients (16 %) underwent a CPM. A significantly higher proportion of women undergoing CPM had reconstruction performed (46 %) than those patients not undergoing CPM (15 %) (p < 0.001). Of the 20,760 patients (20 %) who underwent reconstruction, 7410 (36 %) had implant reconstruction, 7705 (37 %) tissue reconstruction, and 1941 (9 %) combined tissue/implant reconstruction; there were no data for 3,702 (18 %). There was an increasing trend of patients undergoing reconstruction from 2004 (n = 3390, 16.3 %) to 2008 (n = 5406, 26 %) (p < 0.001). On multivariable analysis, significant variables predicting CPM included age <45 years, stage I disease (odds ratio [OR] 1.44, 95 % confidence interval [CI] 1.35–1.54), lobular histology (OR 1.15, 95 % CI 1.11–1.20), and undergoing breast reconstruction (OR 3.58, 95 % CI 3.41–3.75).Conclusions
Besides age, undergoing reconstructive surgery is the factor most strongly associated with CPM. This suggests that apart from risk reduction, the availability of and/or patient willingness to undergo breast reconstruction may influence the decision to undergo CPM. 相似文献10.
Megan E. Miller MD Tomasz Czechura MPH Brigid Martz CCRP Mary E. Hall BS Catherine Pesce MD Nora Jaskowiak MD David J. Winchester MD Katharine Yao MD 《Annals of surgical oncology》2013,20(13):4113-4120
Background
The purpose of this study was to determine if newly diagnosed breast cancer patients undergoing contralateral prophylactic mastectomy (CPM) experience more complications than patients undergoing unilateral mastectomy (UM).Methods
A total of 600 patients underwent either UM or CPM between January 2009 and March 2012 for unilateral breast cancer. Operative complications were classified as minor (aspirations, infection requiring antibiotics, partial flap and nipple necrosis, minor bleeding, delayed wound healing) or major (hematoma or seroma requiring operation, infection requiring rehospitalization, blood product transfusion, total flap or nipple loss, implant removal), mixed (both minor and major complications), or multiple. Chi-square and multivariate logistic regressions were used for the analysis.Results
Of the 600 patients, 391 (65 %) underwent UM and 209 (35 %) underwent CPM. Across all complication groups, there were significantly more complications in the CPM group versus the UM group (41.6 vs. 28.6 %, p = 0.001). Major complications alone were significantly greater in the CPM versus the UM group (13.9 vs. 4.1 %, p < 0.001). When adjusting for age, body mass index, smoking and diabetes history, AJCC stage, reconstruction, previous radiation therapy, and adjuvant therapy, CPM patients were 1.5 times more likely to have any complication (odds ratio [OR] 1.53; 95 % CI 1.04–2.25, p = 0.029) and 2.7 times more likely to have a major complication compared with UM patients (OR 2.66; 95 % CI 1.37–5.19, p = 0.004).Conclusions
CPM patients have an increased risk of complications, especially major complications requiring rehospitalization or reoperation. These complications may influence patient and physician decisions to choose CPM. 相似文献11.
Background
There has been an increasing trend toward contralateral prophylactic mastectomy (CPM) in the management of breast cancer (BCa). This study??s objective was to compare clinicopathologic characteristics of BCa patients who elected CPM to those who elected unilateral total mastectomy (UTM) and to determine whether CPM improved survival.Methods
Comparison was performed on 355 patients with stage 0?CIII BCa matched by age and stage who underwent mastectomy from 1995 to 2008: 177 patients had CPM; 178 patients had UTM. Clinicopathological characteristics and survival outcomes were analyzed.Results
Women who underwent preoperative MRI were twice as likely to have CPM (40.9 vs. 19.7%, P?0.001). MRI identified additional suspicious foci in 45% CPM and 19% UTM. Patients with history of previous breast biopsies, family history, or BRCA mutation were more likely to choose CPM than UTM (40.1 vs. 24%, P?=?0.001; 64.3 vs. 41.4%, P?0.001; 20.3 vs. 6.5%, P?=?0.04, respectively). CPM patients elected nipple preservation (26 vs. 5.2%, P?0.001) and immediate reconstruction more often (92.2 vs. 73.5%, P?0.001); UTM patients were more likely to have attempted breast conservation prior to mastectomy (52.8 vs. 39.5%, P?=?0.01). CPM identified occult BCa in 11 patients (6.6%), and three UTM patients (1.7%) developed contralateral BCa. With median follow-up of 61?months, by univariable/multivariable analyses, CPM did not improve overall, disease-free, or distant metastases-free survival.Conclusion
Factors that may influence choice of CPM included preoperative MRI, history of prior breast biopsies, immediate reconstruction, nipple preservation, family history, and BRCA status. Those who chose CPM did not have improved survival. 相似文献12.
Abstract: Prophylactic mastectomy may be an appropriate treatment for several groups of women. These groups include women with a strong family history of breast cancer, especially those with known BRCA mutations, women with high risk pathologic changes found on previous breast biopsies, women with an immobilizing fear of developing breast cancer, and women with contralateral breast cancer. The effectiveness of prophylactic mastectomy is controversial although recent data suggests a possible gain in life expectancy for high risk women undergoing bilateral prophylactic mastectomy. Each woman should have a thorough discussion with her treatment team, which should include a oncologic surgeon, plastic surgeon, psychologist, and genetic counselor, to realistically assess her risk due to family history, genetic mutations, or high risk pathologic findings, as well as the expectations and limitations of prophylactic mastectomy. 相似文献
13.
Dustin L. Eck MD Galen Perdikis MD Bhupendra Rawal MS Sanjay Bagaria MD Sarah A. McLaughlin MD 《Annals of surgical oncology》2014,21(10):3297-3303
Background
Contralateral prophylactic mastectomy (CPM) is expected to add surgical morbidity but this incremental risk has not yet been defined. We sought to quantify the additional risks associated with CPM and determine how these risks influence the time to adjuvant therapy.Methods
We identified women undergoing mastectomy for unilateral breast cancer and stratified them according to the use of CPM and the presence and laterality of surgical complications. We measured time to adjuvant therapy.Results
Of 352 patients, 205 (58 %) underwent unilateral mastectomy (UM) and 147 (42 %) underwent bilateral mastectomy (BM) [BM = UM + CPM]. Overall, 94/352 (27 %) women suffered 112 complications (BM: 46/147 [31 %] vs. UM: 48/205 [23 %]; p = 0.11), of which hematoma, skin necrosis, cellulitis, or seroma accounted for 94/112 (84 %) complications. Reoperation was required in 37/352 (10 %) women. Among those undergoing BM, morbidity occurred only in the prophylactic breast in 19/147 (13 %) women and risk did not differ with immediate reconstruction (13/108 [12 %]) or without (6/39 [15 %]). Of these 19 patients, 10 (53 %) required reoperation. Women with any complication had a longer interval to adjuvant therapy when compared with those without (49 days vs. 40 days; p < 0.001). When stratified according to side, complications in the prophylactic breast were not associated with a delay in treatment (UM: 58 days vs. BM: prophylactic side; 41 days vs. BM: cancer side: 50 days; p = 0.73).Conclusions
CPM confers additional morbidity in one in eight women, of whom half require reoperation. Despite this, in our series CPM did not delay adjuvant therapy. Given the rising incidence of patients seeking CPM, they should be informed of this risk. 相似文献14.
Caramarie Guilfoyle MD Moira Christoudias MD Abigail E. Collett BA Edward J. Gracely PhD Thomas G. Frazier MD Andrea V. Barrio MD 《The breast journal》2014,20(1):79-83
Magnetic resonance imaging (MRI) use in the preoperative evaluation of newly diagnosed breast cancer (BC) patients is rising. We evaluated MRI as a function of surgical year with respect to mastectomy and contralateral prophylactic mastectomy (CPM) rates by a single surgeon. From January 2000 to December 2010, 1,279 patients with 1,296 breast cancers were identified. Our breast MRI was installed in April 2006. Mastectomy and CPM rates were evaluated by surgical year and stratified as “pre‐MRI” or “MRI” depending on whether surgery occurred before or after April 2006. There was a significant increase in the percentage of patients undergoing MRI in the “pre‐MRI” versus “MRI” era (17.2% versus 78.7%, p < 0.001). In contrast, mastectomy rates decreased with 29.9% undergoing mastectomy before 2006 versus 24.5% after 2006 (p = 0.038). Except for 2007, where CPM rates dropped to 7.1%, CPM rates increased from 16.7% in 2000 to 51.9% in 2010 (p = 0.033). The use of MRI, additional MRI findings and additional MRI biopsies were not associated with the decision for CPM. Age <50 was the only factor associated with CPM (RR = 2.12, p = 0.001). In our community hospital, mastectomy rates have decreased despite the increased use of preoperative MRI. MRI alone may not explain the increasing rates of mastectomy reported in other series. CPM rates have dramatically increased over time, seemingly independent of MRI use. Prospective studies are needed to assess the role of surgeon bias, along with other factors, in surgical decision making. 相似文献
15.
16.
17.
Natalie B. Jones MD John Wilson PhD Linda Kotur BS CTR Julie Stephens MS William B. Farrar MD Doreen M. Agnese MD 《Annals of surgical oncology》2009,16(10):2691-2696
Background
An increasing trend in the use of contralateral prophylactic mastectomy (CPM) for the treatment of unilateral breast cancer has been observed nationally. The purpose of this study was to confirm this trend and to identify differences between the groups that chose unilateral mastectomy alone or with CPM. 相似文献18.
Catherine Pesce Erik Liederbach Chihsiung Wang Brittany Lapin David J. Winchester Katharine Yao 《Annals of surgical oncology》2014,21(10):3231-3239
Background
Several studies have shown that contralateral prophylactic mastectomy (CPM) provides a disease-free and overall survival (OS) benefit in young women with estrogen receptor (ER)-negative breast cancer. We utilized the National Cancer Data Base to evaluate CPM’s survival benefit for young women with early -stage breast cancer in the years that ER status was available.Methods
We selected 14,627 women ≤45 years of age with American Joint Committee on Cancer stage I–II breast cancer who underwent unilateral mastectomy or CPM from 2004 to 2006. Five-year OS was compared between those who had unilateral mastectomy and CPM using the Kaplan–Meier method and Cox regression analysis.Results
A total of 10,289 (70.3 %) women underwent unilateral mastectomy and 4,338 (29.7 %) women underwent CPM. Median follow up was 6.1 years. After adjusting for patient age, race, insurance status, co-morbidities, year of diagnosis, ER status, tumor size, nodal status, grade, histology, facility type, facility location, use of adjuvant radiation and chemohormonal therapy, there was no difference in OS in women <45 years of age who underwent CPM compared towith those who underwent unilateral mastectomy (hazard ratio [HR] = 0.93; p = 0.39). In addition, Tthere was no improvement in OS in women <45 years of age with T1N0 tumors who underwent CPM versus unilateral mastectomy (HR = 0.85; p = 0.37) after adjusting for the aforementioned factors. Among women ≤45 years of age with ER-negative tumors who underwent CPM, there was no improvement in OS compared with women who underwent unilateral mastectomy (HR = 1.12; p = 0.32) after adjusting for the same aforementioned factors.Conclusions
CPM provides no survival benefit to young patients with early-stage breast cancer, and no benefit to ER-negative patients. Future studies with longer follow-up are required in this cohort of patients. 相似文献19.
Amanda K. Arrington MD Stephanie L. Jarosek MPH Beth A. Virnig PhD MPH Elizabeth B. Habermann PhD MPH Todd M. Tuttle MD MS 《Annals of surgical oncology》2009,16(10):2697-2704
Introduction
Patients with unilateral breast cancer have an increased risk of developing contralateral breast cancer. A recent population-based study demonstrated that the proportion of patients with unilateral breast cancer in the United States who underwent contralateral prophylactic mastectomy (CPM) has increased by 150% in recent years. The current study evaluated patients who underwent breast cancer surgery in a metropolitan-based hospital system to determine factors associated with CPM. 相似文献20.
Differences between Breast Conservation‐Eligible Patients and Unilateral Mastectomy Patients in Choosing Contralateral Prophylactic Mastectomies 下载免费PDF全文
Michael S. Sabel MD Casey T. Kraft BS Kent A. Griffith MS MPH Jessica M. Bensenhaver MD Lisa A. Newman MD MPH Sarah T. Hawley PhD MPH Adeyiza O. Momoh MD 《The breast journal》2016,22(6):607-615
There has been an increasing use of bilateral mastectomy (BM) for breast cancer. We sought to examine our trends among breast conservation (BCT) candidates and women recommended for unilateral mastectomy (UM). Our prospective breast cancer database was queried for women with a first‐time, unilateral breast cancer. Patient and histologic factors and surgical treatment, including reconstruction, were evaluated. A detailed chart review was performed among patients from two representative time periods as to the reasons the patient underwent mastectomy. We identified 3,892 women between 2000 and 2012 of whom 60% underwent BCT, 1092 (28%) had UM and 12% underwent BM. BM rose from 4% in 2000 to a high of 19% in 2011, increasing around 2002 for women <40. BCT was less likely with decreasing age (p < 0.0001), lobular histology (p < 0.0001), higher stage (p < 0.0001) and decreasing BMI (p < 0.0001). Among mastectomy patients, contralateral mastectomy was associated with decreasing age (p < 0.0001), Caucasian race (p < 0.0001), and lower stage (p = 0.005). Over time, indications for mastectomy decreased while patients deemed BCT‐eligible opting for UM or BM increased dramatically. Increases in the use of BM are in large part among women who were otherwise BCT‐eligible. Factors associated with BM use are different for BCT‐eligible patients and those recommended for UM. A better understanding of the factors driving individual patient choices is needed. 相似文献