(Press-News.org) Higher proportions of women eligible for breast conservation surgery (BCS) are undergoing mastectomy, breast reconstruction and bilateral mastectomy (surgical removal of both breasts), with the steepest increases seen in women with lymph node-negative and in situ (contained) disease, according to a report published online by JAMA Surgery.
BCS has been a standard of excellence in breast cancer care and its use for management of early-stage breast cancer had increased steadily since the 1990s. However there is evidence that that trend may be reversing.
Kristy L. Kummerow, M.D., of Vanderbilt University Medical Center, Nashville, Tenn., and her co-authors examined trends nationwide in mastectomy patients eligible for BCS. The authors used the National Cancer Data Base to study more than 1.2 million women treated at centers accredited by the American Cancer Society and the American College of Surgeons Commission on Cancer from January 1998 through December 2011.
The study showed that 35.5 percent of the study group underwent mastectomy. The proportion of BCS-eligible women with early-stage breast cancer who underwent mastectomy increased from 34.3 percent in 1998 to 37.8 percent in 2011. Younger women were more likely to undergo mastectomy regardless of tumor size, while in older women mastectomy was associated with having a tumor greater than 2 centimeters. In women undergoing mastectomy, rates of breast reconstruction increased from 11.6 percent in 1998 to 36.4 percent in 2011. Rates of bilateral mastectomy for unilateral (in one breast) disease increased from 1.9 percent in 1998 to 11.2 percent in 2011.
The authors note that the observed increase in mastectomy rates was largely due to a rise in bilateral mastectomy for unilateral, early-stage disease from 5.4 percent of mastectomies in 1998 to 29.7percent in 2011, with an increase at the same time in reconstructive procedures in this group from 36.9 percent to 57.2 percent.
"Our finding of still-increasing rates of mastectomy, breast reconstruction and bilateral mastectomy in women with early-stage breast cancer using 14 years of data from the NCDB has implications for physician and patient decision making as well as quality measurement. Further research is needed to understand patient, provider, policy and social factors associated with these trends," the authors conclude.
(JAMA Surgery. Published online November 19, 2014. doi:10.1001/jamasurg.2014.2895. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: This material is based on work supported by the Office of Academic Affiliations, Department of Veterans Affairs, Veterans Affairs National Quality Scholars Program and with use of facilities at Veterans Affairs Tennessee Valley Healthcare System, Nashville. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Commentary: The Swinging Pendulum
In a related commentary, Bonnie Sun, M.D., and Michael E. Zenilman, M.D., of Johns Hopkins Medicine, Baltimore, write: "Existing guidelines are in place to ensure that patients are offered the appropriate options. The article by Kummerow et al should at least serve as a wake-up call that as we fulfill that responsibility, and use every modality of care to give patients the best quality of life and survival advantage, the guidelines may need to change again."
(JAMA Surgery. Published online November 19, 2014. doi:10.1001/jamasurg.2014.2902. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: An author made a conflict of interest disclosure. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
INFORMATION:
Media Advisory: To contact author Kristy L. Kummerow, M.D., call Craig Boerner at 615-322-4747 or email craig.boerner@vanderbilt.edu. To contact corresponding commentary author Michael E. Zenilman, M.D., call Vanessa Wasta at 410-614-2916 or email wastava@jhmi.edu. A podcast will be available when the embargo lifts on the JAMA Surgery website at http://bit.ly/1dDjZYQ
MAYWOOD, Ill. - Eighty percent of kidney dialysis patients surveyed were not adequately prepared in the event of an emergency or natural disaster that shut down their dialysis center.
But after receiving individualized education from a multidisciplinary team of doctors, nurses, dieticians and social workers, 78 percent of these patients had become adequately prepared, according to a Loyola University Medical Center study.
Anuradha Wadhwa, MD, and colleagues, reported findings during the ASN Kidney Week 2014 meeting.
Patients with kidney failure rely on dialysis treatments ...
It's known that cholesterol levels typically rise as people age and that high cholesterol levels are associated with increased risk of cardiovascular disease. What's less known is that cholesterol levels begin to decline the more a person ages. Recently, researchers from the University of Texas Medical Branch at Galveston and the University of Kentucky found that differences in one gene can influence a person's cholesterol levels from midlife to late life.
The study, published in the International Journal of Environmental Research and Public Health, analyzed data from ...
MADISON, Wis. -- Each year, the planet balances its budget. The carbon dioxide absorbed by plants in the spring and summer as they convert solar energy into food is released back to the atmosphere in autumn and winter. Levels of the greenhouse gas fall, only to rise again.
But the budget has gotten bigger. Over the last five decades, the magnitude of this rise and fall has grown nearly 50 percent in the Northern Hemisphere, as the amount of the greenhouse gas taken in and released has increased. Now, new research shows that humans and their crops have a lot to do with ...
An international team of researchers analyzing decades of observations from many facilities, including NASA's Swift satellite, has discovered an unusual source of light in a galaxy some 90 million light-years away.
The object's curious properties make it a good match for a supermassive black hole ejected from its home galaxy after merging with another giant black hole. But astronomers can't yet rule out an alternative possibility. The source, called SDSS1133, may be the remnant of a massive star that erupted for a record period of time before destroying itself in a supernova ...
On an archaeology field trip in New Mexico as an undergraduate in 2006, Dana Bardolph noticed something that struck her as an odd gender imbalance: The professor leading the dig was a men, while the graduate assistant and all but two of the 14 undergrads were women.
"And it just got me thinking," Bardolph recalled. "Is this reflective of the profession as a whole, or is it an anomaly?"
The question stayed with her, and four years ago she decided to search for an answer. Her findings -- generated after digging through more than 4,500 peer-reviewed papers in 11 archaeology ...
TORONTO, November 19, 2014 - Today an international team of researchers announced the discovery of two new particles in the baryon family, which makes them cousins of the familiar proton and neutron. The LHCb collaboration at CERN, the European Organization for Nuclear Research, used CERN's Large Hadron Collider to make these discoveries.
The masses of these particles, named Xi_b'- and Xi_b*- had been predicted in a paper published in 2009 by York University Professor Randy Lewis and Richard Woloshyn, scientist at the TRIUMF Lab in Vancouver, using a supercomputer approach ...
Far more breast cancer patients are choosing to undergo mastectomy, including removal of both breasts, instead of choosing breast conservation surgery even when they have early stage disease that is confined to one breast, a Vanderbilt study shows. In the past decade, there have also been marked trends toward higher proportions of women opting for breast reconstruction.
The rates of increase were steepest among women with lymph node-negative and in situ (contained) disease.
This is a reversal of trends seen since the 1990s when breast conservation surgery (BCS) was ...
Delivering stem cell factor directly into damaged heart muscle after a heart attack may help repair and regenerate injured tissue, according to a study led by researchers from Icahn School of Medicine at Mount Sinai presented November 18 at the American Heart Association Scientific Sessions 2014 in Chicago, IL.
"Our discoveries offer insight into the power of stem cells to regenerate damaged muscle after a heart attack," says lead study author Kenneth Fish, PhD, Director of the Cardiology Laboratory for Translational Research, Cardiovascular Research Center, Mount Sinai ...
Tropical Storm Adjali started curving to the southwest on its trek through the Southern Indian Ocean when NASA's Aqua satellite passed overhead on Nov. 19.
The Moderate Resolution Imaging Spectroradiometer or MODIS instrument that flies aboard NASA's Aqua satellite captured a visible picture of Tropical Storm Adjali on Nov. 19 at 9:05 UTC (4:05 a.m. EST). The MODIS image showed that the storm began curving to the southwest, and despite slight weakening, thunderstorms circled around the low-level center.
Adjali was curving to the southwest as it continued to move along ...
Minimum legal drinking age legislation in Canada can have a major impact on young drivers, according to a new study from the Northern Medical Program at the University of Northern British Columbia (UNBC). Drivers just older than the legal age had a significant increase in motor vehicle crashes compared to those immediately under the restriction.
In the study, published this week in the American Journal of Preventive Medicine, Dr. Russ Callaghan and his research team looked at Quebec motor vehicle collision statistics between 2000 and 2012 which involved young drivers. ...
