Patient and surgeon characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer

Amanda K. Arrington, Stephanie L. Jarosek, Beth A. Virnig, Elizabeth B Habermann, Todd M. Tuttle

Research output: Contribution to journalArticle

161 Citations (Scopus)

Abstract

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. Methods. We reviewed the records of all patients who underwent surgical treatment for breast cancer in 2006 and 2007 in a single health care system, which included six different hospitals. Exclusion criteria included preoperative diagnosis of bilateral disease, stage IV disease, and a history of previous breast cancer. We recorded patient, treatment, tumor, and surgeon characteristics. Multivariate logistic regression models were used to predict CPM use. Results. Of 571 eligible patients, 276 (48.3%) underwent breast-conserving surgery (BCS), 130 (22.8%) underwent unilateral mastectomy, and 165 (28.9%) underwent mastectomy and a CPM. Among mastectomy patients, 55.9% underwent CPM. Young age (<40 vs.>55 years), large tumor size (>5 vs.<2 cm), positive family history, lobular histology, multicentric disease, and surgeon gender (female) were independent predictors of increased CPM rates. Body mass index, tumor grade, estrogen receptor status, and preoperative breast magnetic resonance imaging were not associated with increased CPM rates. Conclusions. Our study is the first to evaluate specific surgeon characteristics associated with CPM use. Prospective studies are needed to examine factors affecting patient decision-making to develop resources that may assist patients in this process.

Original languageEnglish (US)
Pages (from-to)2697-2704
Number of pages8
JournalAnnals of Surgical Oncology
Volume16
Issue number10
DOIs
StatePublished - Oct 2009
Externally publishedYes

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Breast Neoplasms
Mastectomy
Logistic Models
Surgeons
Prophylactic Mastectomy
Neoplasms
Segmental Mastectomy
Urban Hospitals
Estrogen Receptors
Decision Making
Histology
Breast
Body Mass Index
Magnetic Resonance Imaging
Prospective Studies
Delivery of Health Care
Therapeutics
Population

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Patient and surgeon characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer. / Arrington, Amanda K.; Jarosek, Stephanie L.; Virnig, Beth A.; Habermann, Elizabeth B; Tuttle, Todd M.

In: Annals of Surgical Oncology, Vol. 16, No. 10, 10.2009, p. 2697-2704.

Research output: Contribution to journalArticle

Arrington, Amanda K. ; Jarosek, Stephanie L. ; Virnig, Beth A. ; Habermann, Elizabeth B ; Tuttle, Todd M. / Patient and surgeon characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer. In: Annals of Surgical Oncology. 2009 ; Vol. 16, No. 10. pp. 2697-2704.
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abstract = "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. Methods. We reviewed the records of all patients who underwent surgical treatment for breast cancer in 2006 and 2007 in a single health care system, which included six different hospitals. Exclusion criteria included preoperative diagnosis of bilateral disease, stage IV disease, and a history of previous breast cancer. We recorded patient, treatment, tumor, and surgeon characteristics. Multivariate logistic regression models were used to predict CPM use. Results. Of 571 eligible patients, 276 (48.3{\%}) underwent breast-conserving surgery (BCS), 130 (22.8{\%}) underwent unilateral mastectomy, and 165 (28.9{\%}) underwent mastectomy and a CPM. Among mastectomy patients, 55.9{\%} underwent CPM. Young age (<40 vs.>55 years), large tumor size (>5 vs.<2 cm), positive family history, lobular histology, multicentric disease, and surgeon gender (female) were independent predictors of increased CPM rates. Body mass index, tumor grade, estrogen receptor status, and preoperative breast magnetic resonance imaging were not associated with increased CPM rates. Conclusions. Our study is the first to evaluate specific surgeon characteristics associated with CPM use. Prospective studies are needed to examine factors affecting patient decision-making to develop resources that may assist patients in this process.",
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