Purpose/Objective(s):

To evaluate clinical factors associated with the choice of mastectomy in patients eligible for breast conservation therapy (BCT) at an academic cancer center.

Materials/Methods:

Between July 2009 and December 2011, 208 women with invasive or non-invasive breast cancers were evaluated in a multidisciplinary breast cancer program at the University of Maryland and underwent surgery. Patients with LCIS and atypical histologies (i.e., lymphoma, sarcoma and phyllodes) were excluded. A total of 131 who were eligible for BCT were analyzed for factors that predicted patient choice of surgery. We used Fisher's Exact Test and Likelihood Ratio to examine whether choice of surgery (mastectomy vs. BCT) differed by clinical characteristics [e.g., age (<60 vs. ≥60), race (white vs. black vs. other), family history (yes vs. no), marital status (married vs. unmarried), clinical T stage (Tis vs. T1 vs. T2), N stage (N1-2 vs. N0), group stage (Stage 0-1 vs. Stage 2-3), histology (DCIS vs. IDC vs. ILC), bilateral disease (yes vs. no), and previous breast cancer (yes vs. no).

Results:

Among all 208 patients who had mastectomy (n = 106), after advanced disease (T3/T4; n = 32), patient choice was the second most commonly cited reason for undergoing mastectomy (n = 29). Other reasons included: poor expected cosmesis (n = 23), multicentric disease (n = 15), prior radiation (n = 5), and persistently positive margins (n = 2). Eleven patients initially deemed eligible for breast conservation were rendered ineligible after MRI findings showed multicentricity or tumor size > 5 cm.

Twenty nine of 131 patients deemed eligible for BCT chose mastectomy. Results of the Fisher's Exact and Likelihood Ratio tests showed that choice of surgery differed significantly by age and marital status. Specifically, patients were more likely to choose mastectomy if they were younger (< 60 years of age; 30% vs. 13% p = 0.02) or married (31% vs. 17% p = 0.04). Choice of surgery did not differ significantly by other clinical characteristics (p values > 0.16). Among younger patients (< 60 years), those who were married were more likely to choose mastectomy over BCT (37% vs. 18%, p = 0.04) while those who were not married were equally likely to choose mastectomy or BCT (25% vs. 21%, p = 0.65).

Within the group of 29 patients that chose mastectomy, 55% underwent breast reconstruction and 40% underwent prophylactic contralateral mastectomy. Post-mastectomy radiation was recommended in 21% of these patients based on pathologic findings at the time of surgery.

Conclusions:

Of the patients who were eligible for BCT, age and marriage were associated with choosing mastectomy. MRI findings alone resulted in 7% of patients initially eligible for breast conservation no longer being eligible for breast conservation.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-15-08.