ONS Connect - July 2008 - (Page 25)

NEwTrEaTmENTS,NEwhOpE Rise in Number of Mastectomies May Be Linked to Increased Use of MRI Detection [By Deborah McBride, RN, MSN, CPON ®, Contributing Editor] N ew techniques for detecting breast cancer may be leading women to have their entire breast removed, according to a study presented at the annual meeting of the American Society of Clinical Oncology held in Chicago, IL, on May 30–June 2. Researchers at the Mayo Clinic reported that the number of women who choose mastectomies rather than lumpectomies increased sharply in 2003, a reversal of the previous trend downward. The study found that women who received breast magnetic resonance imaging (MRI) were significantly more likely to opt for mastectomy than those who did not, although a rise was found in both groups. One possible explanation is that preoperative breast MRI may find cancer in more than one part of the breast, which may lead physicians and patients to choose a mastectomy over a lumpectomy. About half of the lesions detected by MRI are noncancerous and only need to be monitored, but some women with such lesions may still choose mastectomy because they feel anxious or do not want to undergo periodic breast biopsies. Breast-conserving surgery (lumpectomy) plus radiation therapy has been the treatment of choice for most women with early-stage disease since 1990, when a National Institutes of Health Consensus Panel reported that it was as effective as mastectomy for overall survival for most women with stage I and II breast cancer. Soon afterward, mastectomy rates began to decline. But in recent years, surgeons have begun to perform more mastectomies, prompting the Mayo Clinic researchers to conduct this retrospective study. The researchers evaluated mastectomy trends in relation to surgical year and use of preoperative breast MRI among 5,464 women who had surgery for early-stage breast cancer at the Mayo Clinic from 1997–2006. They found that mastectomy rates declined from 45% in 1997 to 30% in 2003 but then rose to 43% in 2006. The percentage of women who had a breast MRI doubled from 11% in 2003 to 22% in 2006. Fifty-two percent of the patients receiving an MRI underwent mastectomy, compared with 38% of the patients who did not have an MRI. The study also showed that mastectomy rates increased in women who did not undergo an MRI from 28% in 2003 to 41% in 2006. Researchers are not clear whether the experience at the clinic reflects that of the entire United States, but some evidence does point to a wider trend. Further studies are necessary to determine which factors are most likely to influence a change in surgical management and how these changes affect the overall survival of women with breast cancer. ✱ Yabroff, K.R., Lamont, E.B., Mariotto, A., Warren, J.L., Topor, M., Meekins, A., et al. (2008, May). Trends in mastectomy rates at the Mayo Clinic Rochester: Effect of surgical year and pre-operative MRI [Abstract 509]. Presented at the Annual Meeting of the American Society of Clinical Oncology, Chicago, IL. Contributing Editor Deborah McBride, RN, MSN, CPON ®, is a nurse at the Kaiser Permanente Oakland Medical Center and a faculty member at Samuel Merritt College in Oakland, CA. July 2008 ONS CONNECT 25

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ONS Connect - July 2008 Contents Editor's Note Just In Technologic Advancements in Cancer Care A Year in the Life - Month Seven Web Connect Capitol Connection Notice Nursing Now Caregiver Care Computerized System Standardizes Symptom Assessment and Management Nanotechnology Treats Cancer at the Atomic Level Rise in Mastectomies May Be Linked to Increased Use of MRI Detection Working for You Calendar of Events Staying on Top

ONS Connect - July 2008

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