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Mastectomy Rates Are Rising

And breast-conserving surgery rates are falling — Can preoperative MRI be responsible?

Twenty years ago, randomized trials showed that survival after breast-conserving therapy (lumpectomy plus radiation) was equivalent to survival after mastectomy for women who had localized breast cancer. At that time, more women began choosing breast-conserving therapy, and mastectomy rates dropped. However, recent surveys suggest that this trend is reversing: One theory is that increasing use of preoperative magnetic resonance imaging (which detects more occult lesions, both benign and malignant, than does mammography) is at least partly responsible.

Mayo Clinic researchers identified 5405 women who underwent breast cancer surgery from 1997 through 2006. Mastectomy rates decreased from 1997 to 2003 (from 45% to 31%) but increased from 2003 to 2006 (from 31% to 43%), when women increasingly underwent preoperative MRI. During the latter interval, MRI recipients were significantly more likely to undergo mastectomy than were MRI nonrecipients (54% vs. 36%). However, mastectomy rates also increased among those who did not undergo MRI; undergoing MRI was only one of many variables that were associated independently with mastectomy in a multivariate analysis.

Comment: The observed increase in mastectomy rate is occurring in the absence of any new evidence that long-term outcomes are better with this approach than with breast-conserving approaches. Increasing use of preoperative MRI explains only some of this trend. Editorialists call the increasing use of preoperative MRI "regrettable" and the increasing rates of mastectomy "troubling."

— Allan S. Brett, MD

Published in Journal Watch General Medicine October 1, 2009

Citation(s):

Katipamula R et al. Trends in mastectomy rates at the Mayo Clinic Rochester: Effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol 2009 Sep 1; 27:4082.

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• Medline abstract (Free)

Morrow M and Harris JR. More mastectomies: Is this what patients really want? J Clin Oncol 2009 Sep 1; 27:4038.

• Original article (Subscription may be required)
• Medline abstract (Free)

Reader Remarks:

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• Mastectomy over Lumpectory and Radiation
  Richard R Thornton, MD;ACOG, Retired, 4 Oct 2009 4:01 AM EST
  What is the trade off here? What is the function for retaining the breast which developed a focus of cancer?... [more]
• Why is mastectomy "troubling"?
  M.L. Henneman, 10 Nov 2009 11:14 PM EST
  We hear this over and over again, that women *should* be choosing lumpectomy and radiation over mastectomy, as if "survival'... [more]
• possible cause
  Dr.KEWAL. KRISHEN THASSU, 10 Nov 2009 11:23 PM EST
  With increasing bombardment of cancer related Ads. on T.V. and Media ,there is increased fobia among people about cancer.Probably people... [more]