COMMENTARY

Double Mastectomy Delays Chemo -- Hurts Survival?

Lidia Schapira, MD

Disclosures

May 09, 2014

Impact of Bilateral Versus Unilateral Mastectomy on Short Term Outcomes and Adjuvant Therapy, 2003-2010: A Report from the National Cancer Data Base

Sharpe SM, Liederbach E, Czechura T, Winchester DJ, Yao K
Ann Surg Oncol. 2014 Apr 12. [Epub ahead of print]

Study Summary

Sharpe and colleagues used the National Cancer Data Base to study the effect of bilateral mastectomy for early-stage breast cancer on length of hospital stay, readmission rate, 30-day mortality, and time to adjuvant therapy. They reviewed the records of over 300,000 women who had mastectomy as the primary surgical modality. Of these, 81% had unilateral mastectomy (UM) and 19% opted for bilateral mastectomies (BM). A total of 25% of the sample underwent reconstruction.

The authors found that the median number of days from diagnosis to UM increased from 10 days in 2003 to 28 days in 2010, and for BM it increased from 21 days to 31 days. Patients who had reconstruction were twice as likely to have a longer time to surgery. Women treated at an academic institution were twice as likely to have a delay as those treated in community hospitals; those in the Northeast were nearly 3 times as likely to have a longer time to surgery than patients in the South. These delays accounted for longer time to initiation of radiation or effective systemic therapy (chemotherapy and endocrine therapy).

The authors said they were not able to determine whether these delays have clinical significance, such as an effect on outcome. They plan to continue their research in order to study this important question that may influence counseling of future patients at the time of their initial diagnosis.

Commentary

The authors begin by acknowledging the recent increase in bilateral mastectomies for patients diagnosed with early-stage breast cancer, a trend that is entirely driven by patients rather than experts. They also point out that surgeons typically address reasons for and possible benefits of different procedures and often leave out the possible (unintended) harm caused by such procedures or options. In this case, it is important for clinicians to figure out whether a delay in the initiation of chemotherapy could result in harm.

Longer wait times may be related to the practice of obtaining additional preoperative imaging with MRI, or consultations with plastic surgery or genetic specialists for second opinions. National guidelines from the National Comprehensive Cancer Network[1] and the National Quality Forum[2] recommend adjuvant chemotherapy to be administered within 120 days of diagnosis of breast cancer. In order to provide sound advice to women who are newly diagnosed, surgeons and oncologists need to consider the possible harm of delaying systemic therapy in order to perform more extensive surgeries that may not extend patient survival.

Abstract

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