Of the patients who were eligible for breast conservation therapy (BCT), younger age and being married were associated with choosing mastectomy.
Adam S. Reese, MD, MS, S.B. Kesmodel, MD, J.B. Reese, PhD, E.C. Bellavance, MD, C. Campassi, MD, K.H. Tkaczuk, MD, T. Bao, MD, S.S. Chumsri, MD, J.A. Olsen, MD, S.J. Feigenberg, MD; University of Maryland Medical Center
Purpose and Objectives: To evaluate clinical factors associated with the choice of mastectomy in patients eligible for breast conservation therapy (BCT).
Materials and Methods: Between July 2009 and December 2011, a total of 208 women with invasive or noninvasive breast cancers were evaluated in a multidisciplinary breast cancer program at the University of Maryland and underwent surgery. Patients with lobular carcinoma in situ (LCIS) and atypical histologies (ie, lymphoma, sarcoma, and phyllodes) were excluded. A total of 131 who were eligible for BCT were analyzed for factors that predicted patient choice of surgery. We used Fisher’s exact test and likelihood ratio to examine whether choice of surgery (mastectomy vs BCT) differed by clinical characteristics (eg, age [< 60 vs ≥ 60 y], race [white vs black vs other], family history [yes vs no], marital status [married vs unmarried], clinical T-stage [Tis vs T1 vs T2], N-stage [N1–2 vs N0], group stage [stage 0–1 vs stage 2–3], histology [DCIS vs invasive ductal cancer (IDC) vs invasive lobular cancer (ILC)], bilateral disease [yes vs no], and previous breast cancer [yes vs no]).
Results: Among the 208 patients who had mastectomy (n = 106), after advanced disease (T3/T4; n = 32), patient choice was the second most commonly cited reason for undergoing mastectomy (n = 29). Other reasons included poor expected cosmesis (n = 23), multicentric disease (n = 15), prior radiation (n = 5), and persistently positive margins (n = 2). Eleven patients who were initially deemed eligible for breast conservation were rendered ineligible after magnetic resonance imaging (MRI) findings showed multicentricity or tumor size > 5 cm.
Twenty-nine of 131 patients were deemed eligible for BCT by their multidisciplinary team; yet, 29 chose mastectomy. Results of the Fisher’s exact and likelihood ratio tests showed that choice of surgery differed significantly by age and marital status. Specifically, patients were more likely to choose mastectomy if they were younger (< 60 years of age; 30% vs 13%; P = .02) or married (31% vs 17%; P = .04). Choice of surgery did not differ significantly by other clinical characteristics (P values > .16). Among younger patients (< 60 years), those who were married were more likely to choose mastectomy over BCT (37% vs 18%; P = .04), while those who were not married were equally likely to choose mastectomy or BCT (25% vs 21%; P = .65).
Within the group of 29 patients who chose mastectomy, 55% underwent breast reconstruction and 40% underwent prophylactic contralateral mastectomy. Postmastectomy radiation was recommended in 21% of these patients, based on pathologic findings at the time of surgery.
Conclusions: Of the patients who were eligible for BCT, younger age and being married were associated with choosing mastectomy. MRI findings alone resulted in 7% of patients initially eligible for breast conservation no longer being eligible for breast conservation. Also, 21% of patients who chose mastectomy required adjuvant radiation therapy.