Choosing mastectomy over lumpectomy: Factors associated with surgical decisions in young women with breast cancer.

Health Services Research
Session Type and Session Title: 
Oral Abstract Session, Health Services Research
Abstract Number: 
J Clin Oncol 31, 2013 (suppl; abstr 6507)
Shoshana M. Rosenberg, Karen Sepucha, Kathryn Jean Ruddy, Rulla M. Tamimi, Shari I. Gelber, Meghan E Meyer, Lidia Schapira, Steven E. Come, Virginia F. Borges, Eric P. Winer, Ann H. Partridge; Harvard School of Public Health, Boston, MA; Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; University of Colorado Denver, Aurora, CO

Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy are designated with a caret symbol (^).

Abstract Disclosures


Background: Few studies have comprehensively evaluated surgical decisions in young women with breast cancer. Young women have unique medical and psychosocial concerns, and identifying factors associated with surgical choices in this population can inform their decision-making process. Methods: As part of an ongoing multi-center cohort study enrolling women diagnosed with breast cancer at age 40 or younger, we evaluated 277 women with stage I-III disease who indicated they had a choice between mastectomy and breast conserving surgery (BCS). Logistic regression was used to identify predictors of choosing mastectomy vs. BCS. Independent variables with a p-value ≤ 0.15 in bi-variate analyses were included in the final multivariable model. Results: 172/277 women (62%) had either a single or bilateral mastectomy as their definitive surgery. Median age at diagnosis was 37 (range: 17-40). Most women were married (75%), had stage I or II disease (90%), and estrogen receptor (ER) positive tumors (65%); approximately 14% were carriers of a BRCA 1 or 2 mutation. In the multivariable analysis (Table), having a mutation, nodal involvement, HER2-positivity, tumor grade, lower BMI, having 2 or more children, anxiety, and decisional involvement by the patient were all associated with mastectomy. Age, race, marital status, tumor size, having a first degree relative with breast or ovarian cancer, ER status, fear of recurrence, and depression were not significantly associated with having a mastectomy. Conclusions: Despite being candidates for BCS, many young women choose to have a mastectomy. Our results suggest potential targets for interventions such as anxiety reduction and fostering fully informed shared decision-making.

Significant predictors of mastectomy versus BCS.
OR (95% Cl)
Mutation positive 10.17 (3.25-31.79)
Any nodal involvement 1.88 (1.01-3.52)
HER2 positive 2.41 (1.20-4.82)
Grade (ref=1)
2 3.02 (1.03-8.89)
3 1.78 (0.62-5.08)
Number of children (ref=0)
1 1.44 (0.62-3.34)
≥2 2.20 (1.06-4.54)
BMI 0.92 (0.88-0.97)
Anxiety 2.19 (1.12-4.29)
Decisional involvement (ref=shared)
Mainly patient’s decision 2.07 (1.14-3.76)
Mainly doctor’s decision 0.86 (0.31-2.38)