Breast Cancer Patients With Later Stage Disease More Like To Have Mastectomy

Dr. Rachel A Freedman MD MPH Assistant Professor of Medicine Harvard Medical Interview with:
Dr. Rachel A Freedman MD MPH
Dana-Farber Cancer Institute
Assistant Professor of Medicine
Harvard Medical School

Medical Research: What is the background for this study? What are the main findings?

Dr. Freedman: Despite a lack of medical benefit for most patients, the rates for bilateral mastectomy (double mastectomy) are on the rise in the U.S. Many factors have been cited as potential reasons for this increase, such as one’s race/ethnicity, education level, family history, and use of MRI. Cancer stage has not consistently been a factor in past studies. In this study, we surveyed 487 women who were treated for breast cancer in Northern California within the California Cancer Registry, we examined factors associated with the type of surgery a woman received. In our study, we found strong associations for stage III cancer with receipt of unilateral and bilateral mastectomy. In addition, higher (vs. lower) income and older age were associated with lower odds of having bilateral surgery.

Medical Research: What should clinicians and patients take away from your report?

Dr. Freedman: In this population-based sample, women with the greatest risk of distant recurrence were most likely to undergo bilateral mastectomy despite a lack of clear medical benefit, raising concern for over-treatment. Our findings highlight the need for interventions to assure women are making informed surgical decisions.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Freedman: Our work adds to the body of literature that supports the urgent need for a better understanding and improvement of the breast surgery decision-making process. When making these decisions, in addition to any potential benefits, patients considering bilateral surgery should be counseled about the additional risks associated with more aggressive surgical procedures, the burdens of multi-stage surgeries required during the reconstructive process, the potential impact on sexuality and body image, and the lack of clear medical benefits for most patients.


Brief Report: Higher Stage of Disease is associated with Bilateral Mastectomy among Patients with Breast Cancer: A Population-Based Survey

Freedman, Rachel A. et al. Clinical Breast Cancer

Publication stage: In Press Accepted Manuscript

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