Large Regional Variations in Rates of Contralateral Prophylactic Mastectomy

MedicalResearch.com Interview with:
Rebecca Nash, MPH
Rollins School of Public Health
Emory University

MedicalResearch.com: What is the background for this study?

Response: Contralateral prophylactic mastectomy (CPM) in women with invasive early-stage unilateral breast cancer has significantly increased in the U.S. over the past decade, despite the lack of evidence for a survival benefit. This procedure is particularly common among patients younger than 45 years old. It is also more common in whites compared to blacks, and in privately insured patients compared to uninsured or Medicaid insured patients. However, the extent of regional variation across the United States was unknown.

MedicalResearch.com: What are the main findings?

Response: We found that the overall proportions and the temporal changes in the proportions of women with invasive early-stage unilateral breast cancer undergoing Contralateral prophylactic mastectomy¬†substantially varied by state. Notably, we identified five contiguous Midwest states — Nebraska, Missouri, Colorado, Iowa, and South Dakota–where nearly half of patients 20-44 years old underwent CPM during the most recent time period (2010-2012). These geographic differences were not explained by the state variations in proportions of patients undergoing reconstructive surgery.

MedicalResearch.com: What should readers take away from your report?

Response: There may be geographic differences in physician recommendations for early-stage unilateral breast cancer. Studies have shown that CPM is less likely among patients who are fully informed or whose physicians play a larger role in decision-making. Patients should be educated about the potential harms and benefits associated with contralateral prophylactic mastectomy.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Future studies should examine specific factors that may account for the state variations in use of  contralateral prophylactic mastectomy, particularly the high proportions among younger patients in the Midwest.

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Citation:
Nash R, Goodman M, Lin CC, Freedman RA, Dominici LS, Ward K, Jemal A. State Variation in the Receipt of a Contralateral Prophylactic Mastectomy Among Women Who Received a Diagnosis of Invasive Unilateral Early-Stage Breast Cancer in the United States, 2004-2012. JAMA Surg. Published online March 29, 2017. doi:10.1001/jamasurg.2017.0115

http://jamanetwork.com/journals/jamasurgery/article-abstract/2613702

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