title: Variation in Contralateral Prophylactic Mastectomy Rates According to Racial Groups in Young Women with Breast Cancer, 1998 to 2011: A Report from the National Cancer Data Base.
abstract: BACKGROUND
  The rate of contralateral prophylactic mastectomy (CPM) for unilateral breast cancer has increased over the past decade, particularly for young women. This study investigates the impact of race and socioeconomic status (SES) on use of CPM.
  
  
  METHODS
  Using the National Cancer Data Base (NCDB), we selected 1,781,409 stage 0 to II unilateral breast cancer patients between 1998 and 2011. Trends in use of CPM by race and SES were analyzed using chi-square tests and logistic regression models.
  
  
  RESULTS
  For women of all ages, rates of CPM increased, from 1.9% in 1998 to 10.2% in 2011 (p < 0.001), with higher rates in women ≤45 years old, rising from 3.7% in 1998 to 26.2% in 2011 (p < 0.001). Among young women, white women had the greatest increase in CPM from 4.3% in 1998 to 30.2% in 2011 (p < 0.001). In 2011, CPM rates were 30.2% for white, 18.5% for Hispanic, 16.5% for black, and 15.2% for Asian patients (p < 0.001). The gap in CPM use between white and minority patients persisted in every SES classification, geographic region, and facility type. On multivariate analysis, minority women were 50% less likely to undergo CPM than white women were.
  
  
  CONCLUSIONS
  Young, white, breast cancer patients are twice as likely to undergo CPM compared with women in other racial groups, even after accounting for pathologic, patient, and facility factors. Variations in shared decision-making processes between women of different backgrounds may contribute to these trends, supporting the need for future studies investigating decision-making processes and decisional aids.
authors.affiliation: Department of Surgery, Rush University Medical College, Chicago, IL.
authors.forename: Laura
authors.initials: L
authors.lastname: Grimmer
authors.affiliation: Department of Surgery, NorthShore University Health System, Evanston, IL.
authors.forename: Erik
authors.initials: E
authors.lastname: Liederbach
authors.affiliation: Department of Surgery, NorthShore University Health System, Evanston, IL.
authors.forename: Jose
authors.initials: J
authors.lastname: Velasco
authors.affiliation: Department of Surgery, NorthShore University Health System, Evanston, IL.
authors.forename: Catherine
authors.initials: C
authors.lastname: Pesce
authors.affiliation: Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL.
authors.forename: Chi-Hsiung
authors.initials: CH
authors.lastname: Wang
authors.affiliation: Department of Surgery, NorthShore University Health System, Evanston, IL. Electronic address: kyao@northshore.org.
authors.forename: Katharine
authors.initials: K
authors.lastname: Yao
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000208:ethnology / Q000517:prevention & control* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000208:ethnology / Q000517:prevention & control* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000208:ethnology / Q000517:prevention & control* / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008408:Mastectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D065286:Prophylactic Surgical Procedures / Q000706:statistics & numerical data*; D044469:Racial Groups; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States