K. G. Reddy2, P. D. Strassle2,3, K. P. McGuire1,2 1University Of North Carolina At Chapel Hill,Division Of Surgical Oncology,Chapel Hill, NC, USA 2University Of North Carolina At Chapel Hill,Department Of Surgery,Chapel Hill, NC, USA 3University Of North Carolina At Chapel Hill,Department Of Epidemiology,Chapel Hill, NC, USA
Introduction: Despite the well-documented psychological benefits and oncological safety of post mastectomy breast reconstruction (PMBR), most breast cancer patients do not undergo PMBR. To better understand patterns of PMBR use, it is important to examine the interactions between patient/cancer factors and rates of reconstruction in the breast cancer population. Our main objectives were to determine the following: if reconstruction rates vary across age, if cancer grade and radiation therapy are associated with breast reconstruction, and if the effects of cancer grade and radiation therapy vary across age.
Methods:
Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified women ≥ 18 years old who underwent mastectomy for breast cancer diagnosed between 2000 and 2012. Women with inflammatory BC, Stage IV disease, and bilateral BC were excluded. Multivariable logistic regression, adjusting for clinicopathologic variables, was performed. Age was truncated at 30 (i.e. women ≤30 years old were considered 30 years old) and 90 due to small sample sizes in the tails, and modeled as a quadratic variable as determined by functional form assessment.
Results:
Overall, there were 161,255 women who met the inclusion criteria and 34,432 (21.4%) underwent PMBR. Age was significantly associated with reconstruction, with younger women more likely to undergo PMBR (p<0.0001). Tumor grade and radiation therapy were both significantly associated with PMBR, p=0.05 and p<0.0001, respectively. The effects of tumor grade (p=0.0006.) and radiation ( p=0.001) were also significantly differential across age. Cancer grade only affected PMBR among women <50 years old, with higher grades being associated with increased PMBR. Similarly, while radiation affected PMBR in women <70, the effect was greatest among younger women and was associated with decreased PMBR.
Conclusion:
When compared to their older counterparts, younger breast cancer patients are more likely to undergo post mastectomy breast reconstruction, and have tumor grade and radiation be associated with reconstruction. Further study would be necessary to better elucidate how these factors affect the clinical decision-making process.