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Young Women More Often Choose Mastectomy Over Lumpectomy

July 16, 2013

Written By Robin Warshaw
Reviewed By Suzanne B. Coopey, MD

More than 60 percent of young women who had a choice between mastectomy and lumpectomy as surgical treatment for breast cancer chose mastectomy, according to research presented at the annual meeting of the American Society of Clinical Oncology (ASCO), a major oncology professional organization.

This study was presented as an oral abstract, or poster session. It has not yet been published in a peer-reviewed journal, but its authors include leading breast cancer researchers.

Background and Reason for the Study

Depending on the specifics of their breast cancer diagnoses, young women may be offered a choice between two types of surgical treatment, mastectomy or lumpectomy.

Mastectomy completely removes the affected breast(s) and is often accompanied by breast reconstruction. The surgery is called bilateral mastectomy when both breasts are removed. Lumpectomy, or breast-conserving surgery, removes only a portion of the affected breast and is often followed by radiation therapy.

Though many women can choose either surgery, mastectomy is more often recommended for high-risk women, including those with BRCA gene mutations.

Young women diagnosed with breast cancer have concerns that often differ from those of older women. Such issues may relate to age and life stage, personal relationships, fertility, raising children, career, genetic profile and more. These factors can affect young women’s decision-making about treatment, yet have not been studied much.

The researchers sought to identify factors associated with the surgical choices made by young women. 

Study Structure

Data were drawn from an ongoing larger study of women diagnosed with breast cancer at age 40 and younger. The women evaluated were given a choice between mastectomy or lumpectomy during treatment planning. 

The median age at diagnosis of the 277 women studied was 37 years old. In addition

  • 75 percent were married
  • 90 percent had stage I or II disease
  • 65 percent had estrogen receptor-positive(ER+) breast cancer
  • 14 percent had genetic mutations in BRCA1or 2

Data about the women were analyzed by surgical treatment for stage of disease, estrogen receptor status, marital status, number of children, lymph nodes testing positive for breast cancer, anxiety, family history, and other factors that could have influenced decision-making. The researchers assessed the results to see if there were predictors of surgical choice.

Findings

The researchers found that 172 women (62 percent) had a mastectomy, either single or bilateral.

Factors significantly associated with choosing mastectomy included

  • having a BRCA gene mutation
  • any lymph node involvement
  • having HER2 positive breast cancer
  • lower body mass index (BMI)
  • having 2 or more children
  • anxiety

The final surgical decision was made

  • mainly by the patient (46 percent)
  • between the patient and doctor (46 percent)
  • mainly by the doctor (8 percent)

Women whose decision was mainly their own were much more likely to choose mastectomy despite being candidates for lumpectomy, the researchers said.

Some personal and disease characteristics that might be thought to increase mastectomy rates were found not to be significantly associated with that treatment choice, including marital status, tumor size, having a first-degree relative with breast or ovarian cancer, ER status, fear of recurrence and depression.

The researchers concluded that anxiety reduction and “fully informed shared decision-making” could lower the rate of young women undergoing mastectomies.

What This Means for You

If you were diagnosed recently and are considering your surgical options, take time to ask questions of your breast cancer surgeon and others on your healthcare team. Talk about what you might expect from mastectomy or lumpectomy, including what will happen during the surgery, the current research on outcomes, further treatments that might be needed, breast reconstruction (if wanted) and the risk of developing lymphedema.

Ask why your surgeon recommends one type of surgery, if that is the case. You may get a second opinion from another surgeon if you are uncertain about which is best for you.

The LBBC Guide for the Newly Diagnosed can help you think about surgical decision-making and other concerns. You also may want to call the  Breast Cancer Helpline at (888) 753-LBBC (5222) to speak confidentially with a woman who faced the same decision. Remember, it’s your decision and what was right for someone else might not be right for you.

Rosenberg, SM, Sepucha, K, Ruddy KJ, et al. Choosing mastectomy over lumpectomy: Factors associated with surgical decisions in young women with breast cancer. Journal of Clinical Oncology. 2013. Abstract 6507.

This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

Denver, CO  ·  September 13, 2014

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