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Assessing the Surgical Care of Breast Cancer

Assessing the Surgical Care of Breast Cancer

Clinical trials have shown that survival rates appear to be similar for patients with early-stage breast cancer who are treated with breast-conserving surgery and radiation or with mastectomy. “However, recent studies have indicated that the use of mastectomy is increasing, particularly bilateral mastectomy, among women in the United States with breast cancer,” says Allison W. Kurian, MD, MSc. Typically, bilateral mastectomy is considered both a treatment for the affected breast and a prevention measure for the contralateral breast. Bilateral mastectomy is increasingly being used to treat unilateral breast cancer despite the absence of evidence showing that it offers a survival benefit to the average woman with breast cancer. Bilateral mastectomy has been shown to be an effective secondary prevention strategy for high-risk women with BRCA1/2 mutations, but the procedure may also have detrimental effects. These include higher risks for complications, increased costs, and a negative impact on body image and sexual function. “We need a better understanding of the use of bilateral mastectomy and outcomes associated with its use to improve cancer care,” Dr. Kurian says. A Comprehensive Analysis In a study published in JAMA, Dr. Kurian, Scarlett Gomez, PhD, and colleagues compared the use of bilateral mastectomy, breast-conserving therapy (lumpectomy) with radiation, and unilateral mastectomy and the mortality associated with these procedures. The goals were to determine if there were particular types of patients who were likely to receive a bilateral mastectomy and find out if there were relative differences in mortality among the three procedures. “We could address these questions because we used data from the California Cancer Registry, which covers almost all women diagnosed with breast...
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