Reasons for Mastectomy in Early Stage Breast Cancer: An Institutional Review

Rosebella Agola, MD, MPHGreg Bearden MD, FACSBaptist Health System General Surgery Residency ProgramReasons for Mastectomy in Early Stage Breast Cancer: An Institutional ReviewIntroductionEarly stage breast cancer: cancer that has not spread beyond the breast or axillary lymph nodesStage 0, I and II based on American Joint Commission on Cancer (AJCC) classification

Surgical options for treating early stage breast cancer includeMastectomy: removing entire breastBreast conserving surgery (BCS): removing part of the breast or lumpectomy, followed by radiation therapy.

Using breast conserving surgery (BCS) to treat patients with early stage breast cancer is a nationally accepted standard of care.

A 50% breast conservation rate is considered the minimum standard in order to meet National Accreditation Program for Breast Centers (NAPBC) complianceCompliance is evaluated annually. Published data shows that most centers exceed the 50% BCS rate.

At Princeton Hospital the overall rate of BCS over two years (2010 to 2011) was 54%.

Princeton Hospital BCS RatesComparing 2010 and 2011BCS rate fell from 61% to 50%

ObjectiveTo find out reasons why patients with stage 0-II breast cancer were treated with mastectomy over breast conserving surgery.

Materials and MethodsA retrospective review of data from Princeton Hospitals Breast Cancer registry was conducted to identify patients with Stage 0, I and II breast cancer who were treated with either mastectomy or BCS between 2010 and 2011 Exclusion criteria included surgery done at an outside facility or incomplete data in the medical chart.

Reasons for mastectomy were identified as:Patient choice Surgeon choice Failed BCS (inability to obtain negative margins after lumpectomy)Bilateral breast cancerPrevious breast cancerMulticentricity

Material and MethodsThe medical chart of each patient in the mastectomy group was reviewed to identify reasons for mastectomy.

The following data were also reviewed regarding patient and tumor characteristics in each groupRaceAgeHistologyTumor stageTumor SizeNode status

Patient and tumor characteristics were then independently compared between the BCS group and the mastectomy group. Odds ratios (ORs) were analyzed to determine association with mastectomy. This was done using MS Excel XLSTAT software.

ResultsBetween January 2010 and December 2011, 218 patients had surgery for early stage breast cancer. 28 patients were excluded based on our exclusion criteria.

A total of 190 patients were identified as either having had a mastectomy or BCS at Princeton Hospital 89 patients in the mastectomy group 101 patients in the BCS group.

Patient and tumor characteristics were reviewed and compared according to surgery type.

ResultsResults of medical chart review of mastectomy group79% (70 out of 89) of patients in the mastectomy group had identifiable reasons for mastectomy. Patient choice (31% )Surgeon choice( 3% )Failed BCS(28%)Previous breast cancer (15%)Bilateral breast cancer (9%)Multicentricity (8%)

Mastectomy GroupResults21% (19 out of 89) patients in the mastectomy group had unknown reasons for mastectomy. Characteristics of this group Mean age of 63.All had invasive cancer.63% (12 out of 19) had tumor stage II.68% (13 out of 19) had tumor size < 3cm.68% (13 out of 19) had negative node status.

ResultsPatient and tumor characteristics were analyzed to determine if they were positively associated with mastectomy.

Neither race nor age showed a statistically significant association with increased likelihood of mastectomy (P>0.05, respectively).

Invasive cancer (OR 3.4), positive node status (OR 2.5) tumor stage II (2.23) and tumor size >3cm (OR 3.17) were all independently associated with an increased likelihood of mastectomy over BCS (p