title: A population-based study of breast cancer-specific survival following mastectomy and immediate or early-delayed breast reconstruction.
abstract: Immediate breast reconstruction allows for improved patient psychosocial outcomes after mastectomy. We used the Surveillance, Epidemiology, and End Results (SEER) database to study the breast cancer-specific survival of patients treated with immediate or early-delayed breast reconstruction after mastectomy. Population-level de-identified data was abstracted from the SEER database. All female patients treated with mastectomy for a diagnosis of ductal and/or lobular breast cancer between 1998 and 2002 were included. Breast cancer-specific survival was reported as hazard ratios using multivariate analysis to control for patient demographic and oncologic covariates. Demographic covariates included age, race, marital status, income, education, and county metropolitan status; oncologic covariates included tumor stage, histology, grade, lymph node status, hormone receptor status, receipt of radiation therapy, and unilateral or bilateral mastectomy. A total of 52,249 patients were included in the study. Patients treated with mastectomy and reconstruction had a significantly lower hazard of death (HR 0.73, p < 0.0001) compared with patients treated with mastectomy only. Black patients had a significantly increased hazard of death (HR 1.42, p < 0.0001) compared with white patients. Receipt of radiotherapy did not significantly associate with hazard of death (HR 1.03, p = 0.3494). Additionally, bilateral mastectomy did not significantly associate with hazard of death (HR 0.98, p = 0.763). Our analysis shows that patients who undergo breast reconstruction after mastectomy have a higher breast cancer-specific survival than those undergoing mastectomy alone, when controlling for demographic and oncologic covariates. Further research is required to understand the nature of this relationship.
authors.affiliation: Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA. jay.agarwal@hsc.utah.edu.
authors.forename: Jayant
authors.initials: J
authors.lastname: Agarwal
authors.forename: Shailesh
authors.initials: S
authors.lastname: Agarwal
authors.forename: Lisa
authors.initials: L
authors.lastname: Pappas
authors.forename: Leigh
authors.initials: L
authors.lastname: Neumayer
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000401:mortality*; D008408:Mastectomy / Q000401:mortality*; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D018426:SEER Program; D014481:United States; D044465:White People