(Press-News.org) The choice of contralateral prophylactic mastectomy (CPM) by women with breast cancer (BC) diagnosed in one breast has recently increased in the US but may confer only a marginal life expectancy benefit depending on the type and stage of cancer, according to a study published July 16 in the JNCI: Journal of the National Cancer Institute.
To assess the survival benefit of CPM, Pamela R. Portschy, of the Department of Surgery, University of Minnesota, Minneapolis, and colleagues, developed a model simulating survival outcomes of CPM or no CPM for women with newly diagnosed stage I or II breast cancer, using data from the Surveillance, Epidemiology, and End Results (SEER) registry and large meta-analyses. Survival benefit projections were made for women by age (40, 50, or 60 years), breast cancer stage (I or II), and estrogen receptor (ER) status (positive or negative). Women with BRCA mutations were excluded from the analysis because they have a much higher risk of developing contralateral breast cancer.
The average gain in life expectancy from CPM ranged from 0.13 to 0.59 years for women with stage I BC and from 0.08 to 0.29 years for those with stage II BC. The procedure was more beneficial for younger women and for those with stage I and ER-negative BC. The 20-year disease-free survival benefit ranged from 4.25% to 7.20% for women with stage I BC and from 2.73% to 4.62% for women with stage II BC, depending on age and ER status. However, the 20-year overall survival difference between CPM and no CPM did not exceed 1% for any group.
The authors did not evaluate other outcomes such as surgical complications and quality of life because "…utility values are highly variable between women." They write, "Survival is only one potential benefit of a cancer risk-reduction strategy; effects on cancer-related anxiety, cosmesis, and self-image are also important in decision-making processes." The authors conclude that "Survival estimates derived from our model may be useful for physicians and breast cancer patients to arrive at evidence-based informed decisions regarding CPM."
In an accompanying editorial, Stephen G. Pauker and Mohamed Alseiari of the Division of Clinical Decision Making, Department of Medicine, Tufts Medical Center, Boston, write that although the benefit may be small on average, the choice of prophylactic contralateral mastectomy may not be unreasonable for some women, depending on their family history or genetic background. They write, "The balance between harm and benefit depends on the patient's preferences and highlights the importance of capturing the patient's values and expectations before considering CPM.
INFORMATION:
Contact info:
Todd M. Tuttle, tuttl006@umn.edu
Stephen G. Pauker, spauker@tuftsmedicalcenter.org
Marginal life expectancy benefit from contralateral prophylactic mastectomy
2014-07-16
ELSE PRESS RELEASES FROM THIS DATE:
Screening costs increased in older women without changing detection rates of ESBC
2014-07-16
Medicare spending on breast cancer screening increased substantially between 2001 and 2009 but the detection rates of early stage tumors were unchanged, according to a new study published July 16 in the JNCI: Journal of the National Cancer Institute.
The effect of introduction of new breast cancer screening modalities, such as digital images, computer-aided detection (CAD), and use of ultrasound and MRI on screening costs among older women is unknown, although women over the age of 65 represent almost one-third of the total women screened in the US annually. There is ...
Even mild traumatic brain injury may cause brain damage
2014-07-16
MINNEAPOLIS – Even mild traumatic brain injury may cause brain damage and thinking and memory problems, according to a study published in the July 16, 2014, online issue of Neurology®, the medical journal of the American Academy of Neurology.
For the study, 44 people with a mild traumatic brain injury and nine people with a moderate traumatic brain injury were compared to 33 people with no brain injury. All of the participants took tests of their thinking and memory skills. At the same time, they had diffusion tensor imaging scans, a type of MRI scan that is more sensitive ...
RNs' delayed retirement boosts US nursing supplies, study finds
2014-07-16
Older registered nurses are working longer than in the past, one reason that the nation's supply of RNs has grown substantially in recent years, according to a new study.
Researchers found that from 1991 to 2012, among registered nurses working at age 50, 24 percent remained working as late as age 69. This compared to 9 percent during the period from 1969 to 1990. The findings are published online by the journal Health Affairs.
"We estimate this trend accounts for about a quarter of an unexpected surge in the supply of registered nurses that the nation has experienced ...
Persistent symptoms following concussion may be posttraumatic stress disorder
2014-07-16
Bottom Line: The long-lasting symptoms that many patients contend with following mild traumatic brain injury (MTBI), also known as concussion, may be posttraumatic disorder (PTSD) and not postconcussion syndrome (PCS).
Authors: Emmanuel Lagarde, Ph.D., of the Université de Bordeaux, France, and colleagues.
Background: Concussion accounts for more than 90 percent of all TBIs, although little is known about prognosis for the injury. The symptoms cited as potentially being part of PCS fall into three areas: cognitive, somatic and emotional. But the interpretation of symptoms ...
Study examines shift in resuscitation practices in military combat hospitals
2014-07-16
Bottom Line: Widespread military adoption of damage control resuscitation (DCR) policies has shifted resuscitation practices at combat hospitals during conflicts.
Author: Nicholas R. Langan, M.D., and colleagues from the Madigan Army Medical Center, Tacoma, Wash.
Background: Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) are the first prolonged conflicts the United States has been involved in since the Vietnam War. Medical and surgical advances have often emerged from the battlefields. One of the most important advancements in combat trauma care ...
Study: Smoking may contribute to suicide risk
2014-07-16
AUDIO:
People who smoke cigarettes commit suicide at higher rates than those who don't smoke. That's been known for years, but most scientists assumed the reason was that smoking rates were...
Click here for more information.
Cigarette smokers are more likely to commit suicide than people who don't smoke, studies have shown. This reality has been attributed to the fact that people with psychiatric disorders, who have higher suicide rates, also tend to smoke. But new research ...
Cell membrane proteins give up their secrets
2014-07-16
HOUSTON – (July 16, 2014) – Rice University scientists have succeeded in analyzing transmembrane protein folding in the same way they study the proteins' free-floating, globular cousins.
Rice theoretical biologist Peter Wolynes and his team at the university's Center for Theoretical Biological Physics (CTBP) have applied his energy landscape theory to proteins that are hard to view because they live and work primarily inside cell membranes.
The method should increase the technique's value to researchers who study proteins implicated in diseases and possibly in the ...
Are ants the answer to carbon dioxide sequestration?
2014-07-16
Boulder, Colo. – A 25-year-long study published in Geology on 14 July provides the first quantitative measurement of in situ calcium-magnesium silicate mineral dissolution by ants, termites, tree roots, and bare ground. This study reveals that ants are one of the most powerful biological agents of mineral decay yet observed. It may be that an understanding of the geobiology of ant-mineral interactions might offer a line of research on how to "geoengineer" accelerated CO2 consumption by Ca-Mg silicates.
Researcher Ronald Dorn of Arizona State University writes that over ...
Study: Robot-assisted surgery for prostate cancer controls the disease for 10 years
2014-07-16
DETROIT – Robot-assisted surgery to remove cancerous prostate glands is effective in controlling the disease for 10 years, according to a new study led by researchers at Henry Ford Hospital.
The study also suggested that traditional methods of measuring the severity and possible spread of the cancer together with molecular techniques might, with further research, help to create personalized, cost-effective treatment regimens for prostate cancer patients who undergo the surgical procedure.
The findings apply to men whose cancer has not spread beyond the prostate, and the ...
Seeing the glass as half full: Taking a new look at cognition and aging
2014-07-16
From a cognitive perspective, aging is typically associated with decline. As we age, it may get harder to remember names and dates, and it may take us longer to come up with the right answer to a question.
But the news isn't all bad when it comes to cognitive aging, according to a set of three articles in the July 2014 issue of Perspectives in Psychological Science.
Plumbing the depths of the available scientific literature, the authors of the three articles show how several factors — including motivation and crystallized knowledge — can play important roles in supporting ...