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Equivalent survival after nipple-sparing compared to non-nipple-sparing mastectomy: data from California, 1988–2013

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

ABSTRACT

Purpose

Nipple-sparing mastectomy, which may improve cosmesis, body image, and sexual function in comparison to non-nipple-sparing mastectomy, is increasingly used to treat early-stage breast cancer; however, long-term survival data are lacking. We evaluated survival after nipple-sparing mastectomy versus non-nipple-sparing mastectomy in a population-based cancer registry.

Methods

We conducted an observational study using the California Cancer Registry, considering all stage 0–III breast cancers diagnosed in California from 1988 to 2013. We compared breast cancer-specific and overall survival time after nipple-sparing versus non-nipple-sparing mastectomy, using multivariable analysis.

Results

Among 157,592 stage 0–III female breast cancer patients treated with unilateral mastectomy from 1988–2013, 993 (0.6 %) were reported as having nipple-sparing and 156,599 (99.4 %) non-nipple-sparing mastectomies; median follow-up was 7.9 years. The proportion of mastectomies that were nipple-sparing increased over time (1988, 0.2 %; 2013, 5.1 %) and with neighborhood socioeconomic status, and decreased with age and stage. On multivariable analysis, nipple-sparing mastectomy was associated with a lower risk of breast cancer-specific mortality compared to non-nipple-sparing mastectomy [hazard ratio (HR) 0.71, 95 % confidence interval (CI) 0.51–0.98]. However, when restricting to diagnoses 1996 or later and adjusting for a larger set of covariates, risk was attenuated (HR 0.86, 95 % CI 0.52–1.42).

Conclusions

Among California breast cancer patients diagnosed from 1988–2013, nipple-sparing mastectomy was not associated with worse survival than non-nipple-sparing mastectomy. These results may inform the decisions of patients and doctors deliberating between these surgical approaches for breast cancer treatment.

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References

  1. Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241

    Article  PubMed  Google Scholar 

  2. Kurian AW, Lichtensztajn DY, Keegan TH, Nelson DO, Clarke CA, Gomez SL (2014) Use of and mortality after bilateral mastectomy compared with other surgical treatments for breast cancer in California, 1998–2011. JAMA 312:902–914

    Article  CAS  PubMed  Google Scholar 

  3. Katipamula R, Degnim AC, Hoskin T et al (2009) Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol 27:4082–4088

    Article  PubMed  PubMed Central  Google Scholar 

  4. Jagsi R, Kurian AW, Griffith KA, Hamilton AS, Ward KC, Hawley ST, Morrow M, Katz SJ (2015) Genetic testing decisions of breast cancer patients: results from the iCanCare study. Abstract presented at the American Society of Clinical Oncology Annual Meeting. Chicago, IL, June 2015

  5. Domchek SM, Friebel TM, Singer CF et al (2010) Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA 304:967–975

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. de Alcantara Filho P, Capko D, Barry JM, Morrow M, Pusic A, Sacchini VS (2011) Nipple-sparing mastectomy for breast cancer and risk-reducing surgery: the Memorial Sloan-Kettering Cancer Center experience. Ann Surg Oncol 18:3117–3122

    Article  Google Scholar 

  7. Metcalfe KA, Cil TD, Semple JL et al (2015) Long-term psychosocial functioning in women with bilateral prophylactic mastectomy: does preservation of the nipple-areolar complex make a difference? Ann Surg Oncol 22:3324–3330

    Article  PubMed  Google Scholar 

  8. Yost K, Perkins C, Cohen R, Morris C, Wright W (2001) Socioeconomic status and breast cancer incidence in California for different race/ethnic groups. Cancer Causes Control 12:703–711

    Article  CAS  PubMed  Google Scholar 

  9. Piper M, Peled AW, Foster RD, Moore DH, Esserman LJ (2013) Total skin-sparing mastectomy: a systematic review of oncologic outcomes and postoperative complications. Ann Plast Surg 70:435–437

    Article  CAS  PubMed  Google Scholar 

  10. Adam H, Bygdeson M, de Boniface J (2014) The oncological safety of nipple-sparing mastectomy—a Swedish matched cohort study. Eur J Surg Oncol 40:1209–1215

    Article  CAS  PubMed  Google Scholar 

  11. Agarwal S, Agarwal S, Neumayer L, Agarwal JP (2014) Therapeutic nipple-sparing mastectomy: trends based on a national cancer database. Am J Surg 208:93–98

    Article  PubMed  Google Scholar 

  12. Seki T, Jinno H, Okabayashi K et al (2015) Comparison of oncological safety between nipple sparing mastectomy and total mastectomy using propensity score matching. Ann R Coll Surg Engl 97:291–297

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Yao K, Liederbach E, Tang R et al (2015) Nipple-sparing mastectomy in BRCA1/2 mutation carriers: an interim analysis and review of the literature. Ann Surg Oncol 22:370–376

    Article  PubMed  Google Scholar 

  14. Orzalesi L, Casella D, Santi C et al (2016) Nipple sparing mastectomy: surgical and oncological outcomes from a national multicentric registry with 913 patients (1006 cases) over a 6 year period. Breast 25:75–81

    Article  PubMed  Google Scholar 

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Acknowledgements

This research was funded by the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California. The collection of cancer incidence data used in this study was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #1U58 DP000807-01 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the authors, and endorsement by the University or State of California, the California Department of Health Services, the National Cancer Institute, or the Centers for Disease Control and Prevention or their contractors and subcontractors neither intended nor should be inferred.

Additional funding sources included the Suzanne Pride Bryan Fund for Breast Cancer Research and the Jan Weimer Junior Faculty Chair in Breast Oncology at Stanford University Cancer Institute.

The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

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Correspondence to Christina A. Clarke.

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All research complied with current laws of the United States of America.

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Kurian, A.W., Canchola, A.J., Gomez, S.L. et al. Equivalent survival after nipple-sparing compared to non-nipple-sparing mastectomy: data from California, 1988–2013. Breast Cancer Res Treat 160, 333–338 (2016). https://doi.org/10.1007/s10549-016-3992-8

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