State variation in contralateral prophylactic mastectomy among U.S. women diagnosed with unilateral early stage breast cancer, 2004-2012 Público

Nash, Rebecca (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/8k71nh94z?locale=es
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Abstract

Importance: The use of contralateral prophylactic mastectomy (CPM) among patients with unilateral breast cancer is increasing in the United States. However, the extent of state variation in this trend is unclear.

Objective: To determine state variation in the temporal trend and in the proportion of patients with unilateral breast cancer undergoing CPM.

Design and Settings: A retrospective cohort study of 1.06 million women 20 years of age diagnosed with early stage unilateral breast cancer from 2004 through 2012 and treated with surgery in 46 states and the District of Columbia (representing 91.3% of the US population), as compiled by the North American Association of Central Cancer Registries.

Results: Of the 1.06 million women who underwent surgery for early stage unilateral breast cancer over the nine-year study period (2004-2012), about 93,000 (8.8%) underwent CPM. The proportion of CPM for patients diagnosed in 2004 vs. in 2012 increased from 3.5% to 10.4% for women ages 45 years and from 10.6% to 33.5% for ages 20-44 years nationally. This pattern is evident in all states although the magnitude of the increase varied substantially across states. In women 20-44 years old for example, the proportion of CPM increased by 63% (from 30% during 2004-2006 to 49% during 2010-2012) in South Dakota compared to 420% (from 5% to 27%) in West Virginia. Four contiguous states (NE, CO, IA, SD) showed the highest proportion of CPM (43.6% to 49.2%) in women aged 20-44 during 2010-2012. By region, the South showed the highest CPM proportion and the Northeast the lowest, with adjusted odds ratio of 1.5 (95% confidence interval: 1.46, 1.52). There was evidence that the rate of CPM increase is slowing in every region. Differences in percentage of non-Hispanic white residents accounted for about 12% of the state variation in CPM proportion for patients 20-to-44 years old but not for patients 45 years and older.

Conclusions and Relevance: Despite lack of convincing evidence of a survival benefit, the use of CPM continued to increase in the US with the pattern substantially varying by state. Notably, in four contiguous Western and Midwest states, nearly half of young women underwent CPM in recent years. Differences in racial/ethnic distributions accounted for a small proportion of the CPM state variations for younger women but not for older women.

Table of Contents

Introduction………………………………………………………………………….....1

Methods…………………………………………………………………………………….3

Results……………………………………………………………………………………...6

Discussion………………………………………………………………………………...9

References………………………………………………………………………………..14

Tables and Figures……...…………………………………………………………..17

Appendix…………………………………………………………………………………..28

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