Abstract
Background
Rates of bilateral mastectomy (BM) have increased, but the impact on length of stay (LOS), readmission rate, 30-day mortality, and time to adjuvant therapy is unknown.
Methods
Using the National Cancer Data Base, we selected 390,712 non-neoadjuvant AJCC stage 0–III breast cancer patients who underwent either unilateral mastectomy (UM) or BM from 2003 to 2010 with and without reconstruction. We used chi-square and logistic regression models for the analysis.
Results
A total of 315,278 patients (81 %) had UM, and 75,437 (19 %) had BM; 97,031 (25 %) underwent reconstruction. The number of median days from diagnosis to UM increased from 19 days in 2003 to 28 days in 2010, and for BM, increased from 21 to 31 days (p < 0.001). BM was independently associated with a longer time to surgery when adjusting for patient, facility, and tumor factors and reconstruction (OR 1.11; 95 % CI 1.07–1.15; p < 0.001). Reconstructed patients were twice as likely to have a longer time to surgery (OR 2.07; 95 % CI 2.01–2.14; p < 0.001). The median LOS was 1 day (range 0–184 days) for UM versus 2 (range 0–182) for BM (p < 0.001); 30-day mortality and readmission rates were not different between BM and UM. The median number of days from diagnosis to definitive chemotherapy, hormonal therapy, and radiation therapy was significantly greater in the BM group.
Conclusions
Delays to surgical and adjuvant treatment are significantly longer for BM irrespective of reconstruction, and these delays have increased over the study period. These findings can be used by clinicians to counsel patients on BM.
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References
Yao K, Stewart AK, Winchester DJ, Winchester DP. Trends in contralateral prophylactic mastectomy for unilateral cancer: a report from the National Cancer Data Base, 1998–2007. Ann Surg Oncol. 2010;17:2554–62.
Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;33:5203–9.
Arrington AK, Jarosek SL, Virnig BA, Habermann EB, Tuttle TM. Patient and surgeon characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer. Ann Surg Oncol. 2009;16:2697–704.
King TA, Sakr R, Patil S, Gurevich I, Stempel M, Sampson M, et al. Clinical management factors contribute to the decision for contralateral prophylactic mastectomy. J Clin Oncol. 2011;29:2158–64.
Osman F, Saleh F, Jackson TD, Corrigan MA, Cil T. Increased postoperative complications in bilateral mastectomy patients compared to unilateral mastectomy: an analysis of the NSQIP database. Ann Surg Oncol. 2013;20:3212–7. DOI: 10.1245/s10434-013-3116-1.
Miller ME, Czechura T, Martz B, Hall ME, Pesce C, Jaskowiak N, et al. Operative risks associated with contralateral prophylactic mastectomy: a single institution experience. Ann Surg Oncol. 2013;20:4113–20. DOI: 10.1245/s10434-013-3108-1.
Crosby MA, Garvey PB, Selber JC, Adelman DM, Sacks JM, Villa MT, et al. Reconstructive outcomes in patients undergoing contralateral prophylactic mastectomy. Plast Reconstr Surg. 2011;128:1025–33.
Bleicher RJ, Ruth K, Sigurdson ER, Ross E, Wong YN, Patel SA, et al. Preoperative delays in the US Medicare population with breast cancer. J Clin Oncol. 2012;30:4485–92.
Bilimoria KY, Ko CY, Tomlinson JS, Stewart AK, Talamonti MS, Hynes DL, et al. Wait times for cancer surgery in the United States: Trends and predictors of delays. Ann Surg. 2011;253:779–85.
Wagner JL, Warneke CL, Mittendorf EA, Bedrosian I, Babiera GV, Kuerer HM, et al. Delays in primary surgical treatment are not associated with significant tumor size progression in breast cancer patients. Ann Surg. 2011;254:119–24.
Katipumula R, Degnim AC, Hoskin T, Boughey JC, Loprinzi C, Grant CS, et al. Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol. 2009;27:4082–8.
Bleicher RJ, Ciocca RM, Egleston BL, Sesa L, Evers K, Sigurdson ER, et al. Association of routine pretreatment MRI with time to surgery, mastectomy rate, and margin status. J Am Coll Surg. 2009;209:180–7.
Hulvat M, Sandalow N, Rademaker A, Helenowski I, Hansen NM. Time from diagnosis to definitive operative treatment of operable breast cancer in the era of multimodal imaging. Surgery. 2010;148:746–51.
Sisco M, Du H, Warner JP, Howard MA, Winchester DP, Yao K. Have we expanded the equitable delivery of postmastectomy breast reconstruction in the new millennium? Evidence from the National Cancer Data Base. J Am Coll Surg. 2012;215:658–67.
Landercasper J, Linebarger JH, Ellis RL, Mathiason MA, Johnson JM, Marcou KA, et al. A quality review of the timeliness of breast cancer diagnosis and treatment in an integrated breast center. J Am Coll Surg. 2010;210:449–55.
Desch CE, McNiff KK, Schneider EC, Schrag D, McClure J, Lepisto E, et al. American Society of Clinical Oncology/National Comprehensive Cancer Network Quality Measures. J Clin Oncol. 2008;26:3631–7.
Lohrisch C, Paltiel C, Gelmon K, Spears C, Taylor S, Barnett J, et al. Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol. 2006;24:4888–94.
Colleoni M, Bonetti M, Coates AS, Castiglione-Gertsch M, Gelber RD, Price K, et al. Early start of adjuvant chemotherapy may improve treatment outcome for premenopausal breast cancer patients with tumors not expressing estrogen receptors. J Clin Oncol. 2000;18:584–90.
Benk V, Joseph L, Fortin P, Zhang G, Belisle P, Levinton C, et al. Effect of delay in initiating radiotherapy for patients with early stage breast cancer. J Clin Oncol. 2004;16:6–11.
Jones RVH, Greenwood B. Breast cancer: causes of patients’ distress identified by qualitative analysis. Br J Gen Pract. 1994;44:370–1.
Lai JK, Martin MA, Meyricke R, O’Neill T, Roberts S. Factors associated with short-term hospital readmission rates for breast cancer patients in Western Australia: an observational study. J Am Coll Surg. 2007;204:193–200.
Rosenberg SM, Tracy MS, Meyer ME, Sepucha K, Gelber S, Hirshfield-Bartek J, et al. Perceptions, knowledge, and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer. Ann Intern Med. 2013;159:373–81.
Acknowledgment
We would like to thank the Auxiliary of Evanston and Glenbrook Hospitals for their generous support of this project through the Breast Research Fellowship Program.
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Sharpe, S.M., Liederbach, E., Czechura, T. et al. Impact of Bilateral Versus Unilateral Mastectomy on Short Term Outcomes and Adjuvant Therapy, 2003–2010: A Report from the National Cancer Data Base. Ann Surg Oncol 21, 2920–2927 (2014). https://doi.org/10.1245/s10434-014-3687-5
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DOI: https://doi.org/10.1245/s10434-014-3687-5