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Impact of Availability of Immediate Breast Reconstruction on Bilateral Mastectomy Rates for Breast Cancer across the United States: Data from the Nationwide Inpatient Sample

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Availability of immediate breast reconstruction (IBR) varies among institutions, yet the impact of IBR availability on the rates of bilateral mastectomy (BM) versus unilateral mastectomy (UM) for breast cancer is unknown.

Methods

From the 2002 to 2010 Nationwide Inpatient Sample, we identified women with breast cancer undergoing UM or BM with and without IBR using ICD-9 codes. Hospitals were classified as performing IBR if at least one hospitalization included both mastectomy and reconstruction and then by IBR volume. Statistical comparisons utilized Chi square tests, tests for trend, and multivariable logistic regression.

Results

We identified 130,420 women undergoing UM (76.9 %) or BM (23.1 %) for breast cancer. Of 6,579 hospitals, 3,358 (51.0 %) performed no IBRs, while in the remaining 3,221 hospitals, 1 to 638 IBRs were performed per year. Large, teaching, urban, and Northeastern hospitals were more likely to have higher IBR volumes. BM rates were significantly higher in patients treated at those hospitals with higher IBR volumes, from 33.1 % at hospitals performing ≥24 IBRs per year to 9.0 % at hospitals without IBR (p < 0.001). Upon adjusted analysis, patients who elected BM were more likely to be seen at hospitals performing ≥24 IBRs per year (odds ratio 1.69 vs. UM, p < 0.001).

Conclusions

In this analysis of national data, BM rates were higher in hospitals where IBR was available, suggesting a significant influence of institutional factors on treatment options for breast cancer patients. Efforts are needed to ensure patients have access to IBR when desired and to better understand the reasons for hospital variation in BM rates.

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References

  1. Centers for Medicare and Medicaid Services. Women’s Health and Cancer Rights Act (WHCRA). http://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/whcra_factsheet.html. Accessed April 3, 2014.

  2. Albornoz CR, Bach PB, Mehrara BJ, et al. A paradigm shift in U.S. breast reconstruction: increasing implant rates. Plast Reconstr Surg. 2013;131:15–23.

    Article  PubMed  CAS  Google Scholar 

  3. Cemal Y, Albornoz CR, Disa JJ, et al. A paradigm shift in U.S. breast reconstruction. Part 2. The influence of changing mastectomy patterns on reconstructive rate and method. Plast Reconstr Surg. 2013;131:320e–6e.

    Article  PubMed  CAS  Google Scholar 

  4. Habermann EB, Abbott A, Parsons HM, Virnig BA, Al-Refaie WB, Tuttle TM. Are mastectomy rates really increasing in the United States? J Clin Oncol. 2010;28:3437–41.

    Article  PubMed  Google Scholar 

  5. Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;25:5203–9.

    Article  PubMed  Google Scholar 

  6. Tuttle TM, Jarosek S, Habermann EB, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol. 2009;27:1362–7.

    Article  PubMed  Google Scholar 

  7. Jagsi R, Jiang J, Momoh AO, et al. Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol. 2014;32:919–26.

    Article  PubMed  Google Scholar 

  8. Yao K, Stewart AK, Winchester DJ, Winchester DP. Trends in contralateral prophylactic mastectomy for unilateral cancer: a report from the National Cancer Data Base, 1998–2007. Ann Surg Oncol. 2010;17:2554–62.

    Article  PubMed  Google Scholar 

  9. Heneghan HM, Prichard RS, Lyons R, et al. Quality of life after immediate breast reconstruction and skin-sparing mastectomy—a comparison with patients undergoing breast conserving surgery. Eur J Sug Oncol. 2011;37:937–43.

    Article  CAS  Google Scholar 

  10. Eltahir Y, Werners LL, Dreise MM, et al. Quality-of-life outcomes between mastectomy alone and breast reconstruction: comparison of patient-reported BREAST-Q and other health-related quality-of-life measures. Plast Reconstr Surg. 2013;132:201e–9e.

    Article  PubMed  CAS  Google Scholar 

  11. National Accreditation Program for Breast Centers. 2013 Breast Center Standards Manual. Available at: http://napbc-breast.org/standards/2013standardsmanual.pdf. Accessed May 19, 2014.

  12. Tuggle CT, Patel A, Broer N, Persing JA, Sosa JA, Au AF. Increased hospital volume is associated with improved outcomes following abdominal-based breast reconstruction. J Plast Surg Hand Surg. 2014. doi:10.3109/2000656X.2014.899241.

  13. Albornoz CR, Cordeiro PG, Hishon L, et al. A nationwide analysis of the relationship between hospital volume and outcome for autologous breast reconstruction. Plast Reconstr Surg. 2013;132:192e–200e.

    Article  PubMed  CAS  Google Scholar 

  14. Tanna N, Clayton JL, Roostaeian J, Perry AD, Crisera CA. The volume–outcome relationship for immediate breast reconstruction. Plast Reconstr Surg. 2012;129:19–24.

    Article  PubMed  CAS  Google Scholar 

  15. Hernandez-Boussard T, Zeidler K, Barzin A, Lee G, Curtin C. Breast reconstruction national trends and healthcare implications. Breast J. 2013;19:463–9.

    PubMed  Google Scholar 

  16. Boughey JC, Hoskin TL, Degnim AC, et al. Contralateral prophylactic mastectomy is associated with a survival advantage in high-risk women with a personal history of breast cancer. Ann Surg Oncol. 2010;17:2702–9.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Herrinton LJ, Barlow WE, Yu O, et al. Efficacy of prophylactic mastectomy in women with unilateral breast cancer: a Cancer Research Network project. J Clin Oncol. 2005;23:4275–86.

    Article  PubMed  Google Scholar 

  18. McDonnell SK, Schaid DJ, Myers JL, et al. Efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer. J Clin Oncol. 2001;19:3938–43.

    PubMed  CAS  Google Scholar 

  19. Peralta EA, Ellenhorn JD, Wagman LD, Dagis A, Andersen JS, Chu DZ. Contralateral prophylactic mastectomy improves the outcome of selected patients undergoing mastectomy for breast cancer. Am J Surg. 2000;180:439–45.

    Article  PubMed  CAS  Google Scholar 

  20. van Sprundel TC, Schmidt MK, Rookus MA, et al. Risk reduction of contralateral breast cancer and survival after contralateral prophylactic mastectomy in BRCA1 or BRCA2 mutation carriers. Br J Cancer. 2005;93:287–92.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Yao K, Winchester DJ, Czechura T, Huo D. Contralateral prophylactic mastectomy and survival: report from the National Cancer Data Base, 1998–2002. Breast Cancer Res Treat. 2013;142:465–76.

    Article  PubMed  Google Scholar 

  22. Bedrosian I, Hu CY, Chang GJ. Population-based study of contralateral prophylactic mastectomy and survival outcomes of breast cancer patients. J Natl Cancer I. 2010;102:401–9.

    Article  Google Scholar 

  23. Lostumbo L, Carbine N, Wallace J, Ezzo J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev. 2004;4:CD002748.

  24. Chung A, Huynh K, Lawrence C, Sim MS, Giuliano A. Comparison of patient characteristics and outcomes of contralateral prophylactic mastectomy and unilateral total mastectomy in breast cancer patients. Ann Surg Oncol. 2012;19:2600–6.

    Article  PubMed  Google Scholar 

  25. Frost MH, Slezak JM, Tran NV, et al. Satisfaction after contralateral prophylactic mastectomy: the significance of mastectomy type, reconstructive complications, and body appearance. J Clin Oncol. 2005;23:7849–56.

    Article  PubMed  Google Scholar 

  26. Hershman DL, Richards CA, Kalinsky K, et al. Influence of health insurance, hospital factors and physician volume on receipt of immediate post-mastectomy reconstruction in women with invasive and non-invasive breast cancer. Breast Cancer Res Treat. 2012;136:535–45.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  27. Agarwal S, Pappas L, Neumayer L, Agarwal J. An analysis of immediate postmastectomy breast reconstruction frequency using the Surveillance, Epidemiology, and End Results database. Breast J. 2011;17:352–8.

    Article  PubMed  Google Scholar 

  28. Hartman M, Czene K, Reilly M, et al. Incidence and prognosis of synchronous and metachronous bilateral breast cancer. J Clin Oncol. 2007;25:4210–6.

    Article  PubMed  Google Scholar 

  29. Albornoz CR, Bach PB, Pusic AL, et al. The influence of sociodemographic factors and hospital characteristics on the method of breast reconstruction, including microsurgery: a U.S. population-based study. Plast Reconstr Surg. 2012;129:1071–9.

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA

    Elizabeth B. Habermann PhD, MPH & Kristine M. Thomsen BA

  2. Division of Subspecialty and General Surgery, Mayo Clinic, Rochester, MN, USA

    Tina J. Hieken MD & Judy C. Boughey MD

Authors
  1. Elizabeth B. Habermann PhD, MPH
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  2. Kristine M. Thomsen BA
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  3. Tina J. Hieken MD
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  4. Judy C. Boughey MD
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Corresponding author

Correspondence to Elizabeth B. Habermann PhD, MPH.

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Habermann, E.B., Thomsen, K.M., Hieken, T.J. et al. Impact of Availability of Immediate Breast Reconstruction on Bilateral Mastectomy Rates for Breast Cancer across the United States: Data from the Nationwide Inpatient Sample. Ann Surg Oncol 21, 3290–3296 (2014). https://doi.org/10.1245/s10434-014-3924-y

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  • DOI: https://doi.org/10.1245/s10434-014-3924-y

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