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Twenty years ago, randomized trials showed that survival after breast-conserving therapy (lumpectomy plus radiation) was equivalent to survival after mastectomy for women who had localized breast cancer. At that time, more women began choosing breast-conserving therapy, and mastectomy rates dropped. However, recent surveys suggest that this trend is reversing: One theory is that increasing use of preoperative magnetic resonance imaging (which detects more occult lesions, both benign and malignant, than does mammography) is at least partly responsible.
Mayo Clinic researchers identified 5405 women who underwent breast cancer surgery from 1997 through 2006. Mastectomy rates decreased from 1997 to 2003 (from 45% to 31%) but increased from 2003 to 2006 (from 31% to 43%), when women increasingly underwent preoperative MRI. During the latter interval, MRI recipients were significantly more likely to undergo mastectomy than were MRI nonrecipients (54% vs. 36%). However, mastectomy rates also increased among those who did not undergo MRI; undergoing MRI was only one of many variables that were associated independently with mastectomy in a multivariate analysis.
Katipamula R et al. Trends in mastectomy rates at the Mayo Clinic Rochester: Effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol 2009 Sep 1; 27:4082.
Morrow M and Harris JR. More mastectomies: Is this what patients really want? J Clin Oncol 2009 Sep 1; 27:4038.
Comment
The observed increase in mastectomy rate is occurring in the absence of any new evidence that long-term outcomes are better with this approach than with breast-conserving approaches. Increasing use of preoperative MRI explains only some of this trend. Editorialists call the increasing use of preoperative MRI “regrettable” and the increasing rates of mastectomy “troubling.”