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Annals of Surgical Oncology

, Volume 26, Issue 12, pp 3863–3873 | Cite as

Trends in Unilateral and Contralateral Prophylactic Mastectomy Use in Ductal Carcinoma In Situ of the Breast: Patterns and Predictors

  • Biqi Zhang
  • Suzanne B. Coopey
  • Michele A. Gadd
  • Kevin S. Hughes
  • David C. Chang
  • Tawakalitu O. OseniEmail author
Breast Oncology
  • 85 Downloads

Abstract

Background

Increased use of contralateral prophylactic mastectomy (CPM) as treatment for ductal carcinoma in situ (DCIS) in the US was first noted in the early 2000s. Optimization of treatment guidelines for DCIS requires an understanding of current surgical treatment trends, particularly as they may differ by patient sociodemographic and community resource factors.

Objective

The aim of this study was to evaluate surgical treatment trends among US women with DCIS and to assess the impact of sociodemographic and community resource factors on surgical treatment choice.

Methods

The Surveillance, Epidemiology, and End Results dataset was queried for women aged 40 years and older who were diagnosed with unilateral DCIS between 2000 and 2014. Annual mastectomy rates were compared over time by age and race/ethnicity. Multivariable logistic regressions were performed to identify predictors of mastectomy use, with patient sociodemographics, tumor characteristics, and community resource factors (i.e. plastic surgeon density) as covariates.

Results

A total of 130,731 women with DCIS met the inclusion criteria. Overall mastectomy rates remained relatively unchanged over the study period (25–30%). CPM use increased for all age and race/ethnic groups, with the greatest increase exhibited by women aged 40–49 years [relative to 2000; 2014 odds ratio (OR) 10.6]. With respect to community resource factors, CPM use, as opposed to unilateral mastectomy, was associated with counties of higher education level (OR 1.52), higher income level (OR 1.22), and lower plastic surgeon density (OR 1.26).

Conclusion and Relevance

While the popularity of mastectomy in the management of DCIS has remained relatively unchanged since the turn of the century, the use of CPM has risen substantially. Younger women with DCIS have seen the greatest increase in CPM use, a choice that remains influenced by race/ethnicity as well as income, education, and health resource availability. Until clinical risk stratifiers of DCIS are identified, the surgical decision-making paradigm must be improved so that treatment choice remains sensitive to cultural differences but becomes independent of income, education, and health resource availability.

Notes

Author’s contributions

With regard to Sect. 1 of the journal guidelines, the authors made significant contributions in the following areas: Biqi Zhang, BS: (1) Study conception and design, data acquisition, data interpretation/analysis; (2) drafting the article and revising it critically for important intellectual content; and (3) gave final approval of the version to be published. Suzanne B. Coopey, MD: (1) Data interpretation/analysis; (2) revising the article critically for important intellectual content; and (3) gave final approval of the version to be published. Michele A. Gadd, MD: (1) Data interpretation/analysis; (2) revising the article critically for important intellectual content; and (3) gave final approval of the version to be published. Kevin S. Hughes, MD: (1) Data interpretation/analysis; (2) revising the article critically for important intellectual content; and (3) gave final approval of the version to be published. David C. Chang, PhD, MPH, MBA: (1) Study conception and design, data acquisition, data interpretation/analysis;(2) drafting the article and revising it critically for important intellectual content; and (3) gave final approval of the version to be published. Tawakalitu O. Oseni, MD: (1) Study conception and design, data interpretation/analysis; (2) drafting the article and revising it critically for important intellectual content; and (3) gave final approval of the version to be published.

Disclosures

Biqi Zhang, Suzanne B. Coopey, Michele A. Gadd, Kevin S. Hughes, David C. Chang, and Tawakalitu O. Oseni have no conflicts of interest to declare.

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Biqi Zhang
    • 1
    • 2
  • Suzanne B. Coopey
    • 1
  • Michele A. Gadd
    • 1
  • Kevin S. Hughes
    • 1
  • David C. Chang
    • 1
    • 2
  • Tawakalitu O. Oseni
    • 1
    Email author
  1. 1.Department of SurgeryMassachusetts General Hospital/Harvard Medical SchoolBostonUSA
  2. 2.Codman Center for Clinical Effectiveness in SurgeryMassachusetts General HospitalBostonUSA

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