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Sarah T. Hawley, PhD, MPH University of Michigan Ann Arbor VA Medical Center

Factors Associated with Bilateral vs. Unilateral Mastectomy in a Diverse, Population-based Sample of Breast Cancer Patients. Sarah T. Hawley, PhD, MPH University of Michigan Ann Arbor VA Medical Center. Acknowledgements. Amy Alderman, MD Reshma Jagsi, MD, DPhil Jennifer Griggs, MD, MPH

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Sarah T. Hawley, PhD, MPH University of Michigan Ann Arbor VA Medical Center

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  1. Factors Associated with Bilateral vs. Unilateral Mastectomy in a Diverse, Population-based Sample of Breast Cancer Patients Sarah T. Hawley, PhD, MPH University of Michigan Ann Arbor VA Medical Center

  2. Acknowledgements Amy Alderman, MD Reshma Jagsi, MD, DPhil Jennifer Griggs, MD, MPH Nancy Janz PhD Ann Hamilton, PhD John Graff, PhD Steven Katz, MD University of Michigan Ann Arbor VA Medical Center Los Angeles and Detroit Metropolitan Area SEER Registries University of Southern California and Wayne State University Funded by the National Cancer Institute (R01 CA088370)

  3. Background • Rates of bilateral mastectomy among women with cancer in one breast have been increasing over the past decade • Bilateral mastectomy has been associated with younger age, white race, previous cancer diagnosis, lobular histology(Tuttle 2009, Tuttle 2007)

  4. Gaps in Research • Few studies have patient report of receipt of bilateral mastectomy • Lack of good measures of the role of family history or genetic predisposition • No large studies have included patient attitudes toward surgical treatment decision making • Decision-making for bilateral vs. unilateral mastectomy or lumpectomy may be different

  5. Research Objectives • To evaluate rates of bilateral mastectomy in a racially/ethnically diverse, population based sample of recently diagnosed breast cancer patients • To compare factors associated with receipt of bilateral mastectomy to unilateral mastectomy and lumpectomy

  6. Study Sample • All women age < 79 with ductal carcinoma in situ (DCIS) and a 20% random sample of those with invasive cancer reported to the Detroit and Los Angeles SEER registries in 2002 • Surveyed a mean of 9 months post-diagnosis • 2,647 accrued, 2,382 eligible, 1,844 responded (RR=77.4%) • Survey data merged to SEER data

  7. Measures • Primary outcome: type of surgery received obtained from patient self-report • Any mastectomy vs. lumpectomy • Bilateral vs. unilateral mastectomy • Independent variables • Patient demographics (age, race, education, marital status) • 1st degree family history • Tumor stage

  8. Patient Attitudes Toward Surgery When decisions were being made about your surgery, how important was it to you that the type of surgery you had:

  9. Analytic Methods • Descriptive statistics across all variables • Chi-square and t-tests used to examine differences in surgery received and independent variables • Two-part logistic regression model: • Any mastectomy vs. lumpectomy • Bilateral vs. unilateral mastectomy

  10. Sample Characteristics (N=1,844)

  11. Patient attitudes toward surgery

  12. Overall rates of surgery

  13. Mastectomy-treated patients

  14. Factors Associated with Surgery Any mastectomy vs. lumpectomy (N=1,844) Bilateral vs. unilateral mastectomy (N=646) Demographics Age White (vs. Non-white) 1.00 (0.99-1.02) 1.16 (0.84-1.61) 0.94 (0.92-0.97) 1.58 (1.20-1.86) 1st degree family history 1.10 (0.61-1.18) 3.00 (1.36-3.61) Stage 0 Stage I Stage II Stage III 1.30 (0.84-2.01) 1.00 1.87 (1.18-2.95) 4.97 (2.51-9.83)* 0.75 (0.35-1.63) 1.00 0.89 (0.37-2.16) 0.41 (0.10-1.62)** Patient attitudes Recurrence concerns Body image concerns 6.77 (4.67-9.82) 0.57 (0.38-0.84) 2.76 (1.14-6.68) 1.00 (0.50-2.01) * Wald Chi-square=25.26, p=0.000 ** Wald Chi-square=1.83, p=0.607

  15. Limitations • Cross sectional survey • Small absolute number of bilateral mastectomy • May not be generalizable outside of Detroit or Los Angeles • No information regarding patient use of genetic testing and/or genetic mutations

  16. Summary • Decision making for any mastectomy vs. lumpectomy is different from that for bilateral vs. unilateral mastectomy • The former is driven largely by stage and patient attitudes • The latter is associated with high risk for a new primary (younger age, white race, 1st degree family history) • Patient concerns about recurrence appear to affect bilateral mastectomy decisions

  17. Implications • Further work to evaluate how and when women make bilateral mastectomy decisions is needed • Providers need to be prepared to discuss bilateral mastectomy with patients • Tools to help women understand the risks and benefits of bilateral mastectomy vs. other surgical options may be useful in decision making • Family history • Risk of recurrence

  18. Thank you

  19. CanSORT www.cansort.org

  20. Patient report vs. SEER

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