Freedman Rachel A, Kouri Elena M, West Dee W, Rosenberg Shoshana, Partridge Ann H, Lii Joyce, Keating Nancy L
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
Harvard Medical School, Department of Health Care Policy, Boston, MA.
Clin Breast Cancer. 2016 Apr;16(2):105-12. doi: 10.1016/j.clbc.2015.08.004. Epub 2015 Aug 28.
The reasons for increasing rates of bilateral mastectomy for unilateral breast cancer are incompletely understood, and associations of disease stage with bilateral surgery have been inconsistent. We examined associations of clinical and sociodemographic factors, including stage, with surgery type and reconstruction receipt among women with breast cancer.
We surveyed a diverse population-based sample of women from Northern California cancer registries with stage 0 to III breast cancer diagnosed during 2010-2011 (participation rate, 68.5%). Using multinomial logistic regression, we examined factors associated with bilateral and unilateral mastectomy (vs. breast-conserving surgery), adjusting for tumor and sociodemographic characteristics. In a second model, we examined factors associated with reconstruction for mastectomy-treated patients.
Among 487 participants, 58% had breast-conserving surgery, 32% had unilateral mastectomy, and 10% underwent bilateral mastectomy. In adjusted analyses, women with stage III (vs. stage 0) cancers had higher odds of bilateral mastectomy (odds ratio [OR], 8.28; 95% confidence interval, 2.32-29.50); women with stage II and III (vs. stage 0) disease had higher odds of unilateral mastectomy. Higher (vs. lower) income was also associated with bilateral mastectomy, while age ≥ 60 years (vs. < 50 years) was associated with lower odds of bilateral surgery. Among mastectomy-treated patients (n = 206), bilateral mastectomy, unmarried status, and higher education and income were all associated with reconstruction (P < .05).
In this population-based cohort, women with the greatest risk of distant recurrence were most likely to undergo bilateral mastectomy despite a lack of clear medical benefit, raising concern for overtreatment. Our findings highlight the need for interventions to assure women are making informed surgical decisions.
单侧乳腺癌双侧乳房切除术发生率上升的原因尚未完全明确，疾病分期与双侧手术之间的关联也不一致。我们研究了包括分期在内的临床和社会人口学因素与乳腺癌女性手术类型及是否接受重建之间的关联。
我们对来自北加利福尼亚癌症登记处的不同人群样本进行了调查，这些女性在2010 - 2011年期间被诊断为0至III期乳腺癌（参与率为68.5%）。使用多项逻辑回归，我们研究了与双侧和单侧乳房切除术（相对于保乳手术）相关的因素，并对肿瘤和社会人口学特征进行了调整。在第二个模型中，我们研究了乳房切除术后接受重建的相关因素。
在487名参与者中，58%接受了保乳手术，32%接受了单侧乳房切除术，10%接受了双侧乳房切除术。在调整分析中，III期（相对于0期）癌症女性接受双侧乳房切除术的几率更高（比值比[OR]，8.28；95%置信区间，2.32 - 29.50）；II期和III期（相对于0期）疾病女性接受单侧乳房切除术的几率更高。较高（相对于较低）收入也与双侧乳房切除术相关，而年龄≥60岁（相对于<50岁）与双侧手术几率较低相关。在接受乳房切除术的患者（n = 206）中，双侧乳房切除术、未婚状态以及较高的教育程度和收入均与重建相关（P < .05）。
在这个基于人群的队列中，远处复发风险最高的女性最有可能接受双侧乳房切除术，尽管缺乏明确的医学益处，这引发了对过度治疗的担忧。我们的研究结果强调了采取干预措施以确保女性做出明智手术决策的必要性。
