The Effect of Receptor Status on Mastectomy and Contralateral Prophylactic Mastectomy Rates in Early Stage Invasive Breast Carcinoma

Sunil W. Dutta, Daniel Trifiletti, Surbhi Grover, Kara D. Romano, Einsley Marie Janowski, Shayna L. Showalter

Research output: Contribution to journalArticle

Abstract

This study has queried The National Cancer Database of 280,241 patients with breast cancer and clinical T1-T3 N0 M0 disease. We examined the association of receptor status and mastectomy and contralateral mastectomy rates. If tumors were HER2 + , patients were more likely to undergo a mastectomy or contralateral mastectomy. Background: There is an established relationship between hormone receptor (HR; estrogen and/or progesterone receptors) status, HER2 status, and locoregional recurrence. The purpose of this study was to analyze how HR and HER2 receptor status have influenced the surgical management trends among patients with early stage breast cancer. Patients and Methods: The National Cancer Database was queried for patients with cT1 to cT3, cN0, and cM0 breast carcinoma from 2004 to 2012. Patients were grouped on the basis of receptor status and surgical management (mastectomy or breast-conserving surgery [BCS]). Multivariable analyses were performed to investigate factors associated with increased odds of receiving mastectomy over BCS. Among a subgroup of patients who underwent ipsilateral mastectomy, analyses were performed to determine any association between contralateral prophylactic mastectomy (CPM) and receptor status. Results: We found 280,241 patients who met inclusion criteria for analyzing mastectomy or BCS surgical decision. Patients with HER2-positive (HER2 + ) tumors (HR + /HER + and HR /HER2 + ) were the most likely to undergo mastectomy (odds ratio [OR], 1.212 and 1.499 respectively, compared with HR + /HER2 patients, each P <.001). HR status alone did not affect ipsilateral surgical management as patients with HR + /HER2 and HR /HER2 tumors demonstrated similar mastectomy rates (P =.391). Among the 108,018 who underwent mastectomy, 20% underwent CPM. After adjustment, patients with HR + /HER2 + , HR /HER2 + , and HR /HER2 were all more likely to undergo CPM (OR 1.356, 1.608, and 1.358, respectively compared with HR + /HER2 patients, each P <.001). Conclusion: This analysis indicates that patients with early stage breast cancer are more likely to undergo a mastectomy and CPM if they have HER2 + tumors.

Original languageEnglish (US)
Pages (from-to)121-127
Number of pages7
JournalClinical breast cancer
Volume18
Issue number2
DOIs
StatePublished - Apr 1 2018
Externally publishedYes

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Mastectomy
Breast Neoplasms
Segmental Mastectomy
Neoplasms
Prophylactic Mastectomy
Odds Ratio
Databases
Progesterone Receptors
Estrogen Receptors

Keywords

  • Analysis
  • Database
  • HER2
  • Hormone
  • Surgery

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

The Effect of Receptor Status on Mastectomy and Contralateral Prophylactic Mastectomy Rates in Early Stage Invasive Breast Carcinoma. / Dutta, Sunil W.; Trifiletti, Daniel; Grover, Surbhi; Romano, Kara D.; Janowski, Einsley Marie; Showalter, Shayna L.

In: Clinical breast cancer, Vol. 18, No. 2, 01.04.2018, p. 121-127.

Research output: Contribution to journalArticle

Dutta, Sunil W. ; Trifiletti, Daniel ; Grover, Surbhi ; Romano, Kara D. ; Janowski, Einsley Marie ; Showalter, Shayna L. / The Effect of Receptor Status on Mastectomy and Contralateral Prophylactic Mastectomy Rates in Early Stage Invasive Breast Carcinoma. In: Clinical breast cancer. 2018 ; Vol. 18, No. 2. pp. 121-127.
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abstract = "This study has queried The National Cancer Database of 280,241 patients with breast cancer and clinical T1-T3 N0 M0 disease. We examined the association of receptor status and mastectomy and contralateral mastectomy rates. If tumors were HER2 + , patients were more likely to undergo a mastectomy or contralateral mastectomy. Background: There is an established relationship between hormone receptor (HR; estrogen and/or progesterone receptors) status, HER2 status, and locoregional recurrence. The purpose of this study was to analyze how HR and HER2 receptor status have influenced the surgical management trends among patients with early stage breast cancer. Patients and Methods: The National Cancer Database was queried for patients with cT1 to cT3, cN0, and cM0 breast carcinoma from 2004 to 2012. Patients were grouped on the basis of receptor status and surgical management (mastectomy or breast-conserving surgery [BCS]). Multivariable analyses were performed to investigate factors associated with increased odds of receiving mastectomy over BCS. Among a subgroup of patients who underwent ipsilateral mastectomy, analyses were performed to determine any association between contralateral prophylactic mastectomy (CPM) and receptor status. Results: We found 280,241 patients who met inclusion criteria for analyzing mastectomy or BCS surgical decision. Patients with HER2-positive (HER2 + ) tumors (HR + /HER + and HR − /HER2 + ) were the most likely to undergo mastectomy (odds ratio [OR], 1.212 and 1.499 respectively, compared with HR + /HER2 − patients, each P <.001). HR status alone did not affect ipsilateral surgical management as patients with HR + /HER2 − and HR − /HER2 − tumors demonstrated similar mastectomy rates (P =.391). Among the 108,018 who underwent mastectomy, 20{\%} underwent CPM. After adjustment, patients with HR + /HER2 + , HR − /HER2 + , and HR − /HER2 − were all more likely to undergo CPM (OR 1.356, 1.608, and 1.358, respectively compared with HR + /HER2 − patients, each P <.001). Conclusion: This analysis indicates that patients with early stage breast cancer are more likely to undergo a mastectomy and CPM if they have HER2 + tumors.",
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