Medical contraindications are not a major factor in the underutilization of breast conserving therapy.
BACKGROUND
Multiple randomized trials have demonstrated that survival after breast conserving therapy (BCT) is equal to survival after mastectomy, but large population-based studies indicate that > 50% of patients with early stage breast cancer continue to undergo mastectomy. This study was undertaken to determine whether medical contraindications to BCT or patient choice are responsible for high mastectomy rates.


METHODS
Four hundred thirty-two patients with stage 0, I, or II breast carcinoma were prospectively evaluated by a multidisciplinary team for eligibility for BCT. Standard criteria developed by a joint committee of the American College of Surgeons, American College of Radiologists, College of American Pathologists, and Society of Surgical Oncology were used. Eligible patients were offered a choice among BCT, mastectomy, or mastectomy and immediate reconstruction.


RESULTS
Only 97 of the 432 patients had contraindications to BCT. The incidence of contraindications varied by stage: 10% for stage I, 28% for stage II, and 33% for stage 0 (p < 0.01). The type of contraindications also varied with stage. Age, histologic tumor type, and axillary node status (when controlled for tumor size) did not influence rates of BCT. Of eligible patients, 81% chose BCT, independent of age or race.


CONCLUSIONS
Medical contraindications to BCT are not major factors resulting in high mastectomy rates. Strategies like neoadjuvant chemotherapy, which addresses medical contraindications, are unlikely to have a major impact on national rates of BCT.
Morrow
M
M
Department of Surgery, Northwestern University Medical School, Chicago, IL 60611, USA.
Bucci
C
C
Rademaker
A
A
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D002278:Carcinoma in Situ / Q000532:radiotherapy / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000532:radiotherapy / Q000601:surgery*; D000075202:Contraindications; D005260:Female; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D016462:Mammaplasty / Q000706:statistics & numerical data; D008408:Mastectomy / Q000706:statistics & numerical data*; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data; D008875:Middle Aged; D018579:Patient Selection; D010361:Patients / Q000523:psychology; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data