A woman's dilemma: Mastectomy or conservation surgery?

When a woman living in Europe with early-stage breast cancer has a choice, in all likelihood she will select breast conservation surgery. Surgical mastectomies have been in steady decline since 2005, according to an article published in the September issue of the European Journal of Cancer.

A trend analysis of more than 15,000 women registered in eusomaDB, the multi-institutional European database of the European Society of Breast Cancer Specialists (EUSOMA), indicated mastectomy rates declined steadily from 2005 to 2010 for patients with unilateral early-stage breast cancer. In 2005, the adjusted mastectomy trend rate at 13 participating breast units in Austria, Belgium, Germany, Italy, and Switzerland was 31.8%. By 2010, it had dropped to 13.1% (EJC, September 2012, Vol. 48:13, pp. 1947-1956).

The analysis included a total of 15,369 women who had been diagnosed with invasive ductal carcinoma, invasive lobular carcinoma, or ductal carcinoma in situ (DCIS) at stage 0 to stage II, with no more than three involved lymph nodes, who qualified as candidates for breast conservation surgery. Breast conservation surgery was attempted for 83.7% of this total, or 12,865 patients, and was successful for 11,263 women. A total of 10.8% of the patients who elected breast conservation surgery ultimately needed to have a mastectomy performed.

Women who elected to have a mastectomy tended to be younger than age 20 or older than 70. They had a tumor grade of II or III, multiple cancerous lesions, positive axillary nodes, a lobular histology, and/or negative progesterone receptors.

In a separate analysis for calendar year 2010, the multinational research team determined that 30% of women who had a mastectomy also underwent immediate breast reconstruction. By comparison, this rate averaged only 16% between 2005 and 2010, according to lead author Dr. Carlos Garcia-Etienne, of the breast surgery department at the cancer center of the Istituto Clinico Humanitas-IRCCS in Milan, and colleagues.

The breast conservation trends for this group of patients met and then exceeded the target recommendation by EUSOMA that 80% of women who qualify for breast conservation surgery undergo the procedure. In the U.S., this recommendation is 50% or higher from the National Accreditation Center for Breast Cancer Standards.

Comparing their analysis of breast conservation and mastectomy rates with five similar, recent peer-reviewed journal studies about patients treated in the U.S., the authors noted rates of mastectomy for this patient population appear to be lower in Europe. They recommended that on both continents further studies should be undertaken to reliably document preoperative determinants of type of surgery, namely clinical indications versus patient preference, and to identify determinants for reoperation and conversion to mastectomy.

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