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 In recent years, reconstruction following a mastectomy has become
more widely available, contributing to a sharp increase in the
number of women who opt for this treatment even when less aggressive
alternatives may be just as effective, researchers note in the
Journal of the National Cancer Institute.
With early-stage tumors that haven’t spread to distant parts of the
body, survival odds are similar for a mastectomy or a lumpectomy
paired with radiation, previous studies have found.
In the current study, researchers found the risk of complications
with a mastectomy followed by reconstruction was almost twice that
of lumpectomy.
“The vast majority of women with early breast cancer can undergo
breast conserving therapy followed by whole breast irradiation which
allows for preservation of the breast,” said lead study author Dr.
Benjamin Smith, a researcher at the University of Texas MD Anderson
Cancer Center in Houston.
“Our data illuminate that this treatment strategy may very well be
easier on patients from a complication perspective and still allow
them to preserve their body image,” Smith added by email.
Most of these patients have surgery – either a lumpectomy that
removes malignant tissue while sparing the rest of the breast or a
mastectomy that removes the entire breast. After surgery, they may
also get chemotherapy or radiation to destroy any remaining abnormal
cells and reduce the risk of cancer coming back.
To assess complications and costs, researchers analyzed data on
patients diagnosed from 2000 to 2011. The study included 44,344
women under 65 with employer-based health insurance and 60,867 women
at least 66 years old with coverage through Medicare.
Researchers looked for complications such as infections, fluid
buildup, blood clots, lumps of dead tissue or pain in the breast,
inflammation in the lungs, rib fractures, implant removals or graft
failures.
After two years, 30 percent of the younger women experienced
complications with a lumpectomy followed by whole breast radiation,
compared with 54 percent among those who underwent mastectomy paired
with reconstruction. With a mastectomy alone, the complication rate
was 25 percent.
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For older women, 38 percent had complications with a lumpectomy and
radiation, compared with 66 percent for a mastectomy and
reconstruction and 37 percent for a mastectomy alone.
Compared to the lumpectomy and radiation, complication costs were
roughly $9,000 higher for the younger women who got a mastectomy
with reconstruction and $2,000 higher for the older women.
Within two years of diagnosis, the total cost of treatment with a
mastectomy plus reconstructive surgery was $88,000 for the younger
women, $22,000 more expensive than a lumpectomy with whole breast
radiation. In the older group, the mastectomy with reconstruction
was $36,000, which was $2,000 more than the lumpectomy and whole
breast radiation.
One limitation of the study is that the costs come from just 2010
and 2011, the authors note. Because insurance coverage varies, the
study doesn’t show what individual patients may pay out-of-pocket
for their care.
Doctors may recommend a mastectomy when cancer cells remain after a
lumpectomy, or for women who want to avoid radiation or repeated
mammograms, Smith noted.
“Not all patients are eligible for breast conserving surgery; for
patients requiring a mastectomy, reconstruction allows women to have
a breast mound which may be important to them,” Anees Chagpar,
director of the breast center at Smilow Cancer Hospital at Yale-New
Haven in Connecticut, said by email. Chagpar wasn’t involved in the
study.
Early stage breast cancer also includes a lot of women with very
different situations, noted Dr. Lisa Schneider, a plastic surgeon at
the Institute for Advanced Reconstruction in Shrewsbury, New Jersey,
who wasn’t involved in the study.
“Someone with a strong family predisposition who is deeply fearful
of breast cancer and has seen their mother die of cancer may make a
very different choice than someone who has young children . . . or
an elderly parent they need to care for and needs to get back to
work as soon as possible,” Schneider said by email.
SOURCE: http://bit.ly/2dqZsC1 Journal of the National Cancer
Institute, online September 27, 2016.
[© 2016 Thomson Reuters. All rights
reserved.] Copyright 2016 Reuters. All rights reserved. This material may not be published,
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