Mastectomies on the Increase

By Amanda Gardner
HealthDay Reporter
Saturday, May 17, 2008; 3:00 AM

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FRIDAY, May 16 (HealthDay News) -- After years of declining rates, the number of mastectomies performed on women with breast cancer is on the rise again, the Mayo Clinic now reports.

The increase coincided with heavier usage of magnetic resonance imaging (MRI) before surgery, according to the authors, who were expected to present their findings May 31 at the American Society of Clinical Oncology (ASCO) annual meeting, in Chicago.

Guidelines introduced in 1990 pronouncing that lumpectomy was equally effective as mastectomy for overall survival in women with early-stage breast cancer resulted in a rise in lumpectomies, also known as breast-conserving surgery, along with a decline in the number of mastectomies performed.

"But in the last 10 years, more changes have occurred in the preoperative work-up of breast cancer, and some of the changes have included the introduction of new imaging modalities such as MRI," senior study author Dr. Matthew Goetz, an assistant professor of oncology at the Mayo Clinic in Rochester, Minn., said during a May 15 teleconference. "There are also improved breast reconstruction options, as well as the introduction of genetic testing."

Previously published trials have shown that mastectomy rates may be increasing in general in the United States, Dr. Julie Gralow, an associate professor of medical oncology at the University of Washington, Seattle, added at the same news conference.

Dr. Richard J. Bleicher, co-director of the Breast Fellowship Program at Fox Chase Cancer Center in Philadelphia, confirmed this. "This is a real finding. This is not something that is isolated to Mayo. We see the same thing," he said.

Breast MRIs may detect cancer in more than one part of the breast, which, in turn, may prompt surgeons and patients to choose mastectomy over lumpectomy. MRIs also pick up noncancerous masses, which leads women to choose a mastectomy, even though the lesion doesn't need to be removed immediately.

The new research involved more than 5,000 patients with early-stage breast cancer who underwent surgery between 1997 and 2006. Information on whether an MRI was performed before surgery became available in Mayo Clinic records, starting in 2003.