> Table 56: Regional differences in rates of mastectomy in the United States
This summary table contains detailed information about research studies. Summary tables offer an informative look at the science behind many breast cancer guidelines and recommendations. However, they should be viewed with some caution. In order to read and interpret research tables successfully, it is important to understand some key concepts. Learn how to read a research table.
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Introduction: Lumpectomy (also called breast conserving surgery) plus radiation therapy, is as effective as mastectomy in treating early breast cancer (see Table 37). However, rates of these procedures in the United States vary greatly by region. For women of all ages, the lowest rates of mastectomy (and therefore the highest rates of lumpectomy) occur on the East and West Coasts [1-5].
The map below shows in detail how mastectomy rates for women ages 65 and older vary across the nation.
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Blue areas show areas where rates of mastectomy are higher than the national average.
Green areas show areas where rates of mastectomy are lower than the national average.
Reprinted from the Dartmouth Atlas of Health Care (www.dartmouthatlas.org) with permission. Copyright, Trustees of Dartmouth College, 1998.
Note: HRR = hospital referral region
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Why are there regional differences in rates of mastectomy and lumpectomy plus radiation therapy?
Part of the difference in regional rates of mastectomy for women with early breast cancer is due to personal choice. Younger women may prefer to have a lumpectomy plus radiation. Women who live in areas with few facilities that offer radiation therapy (needed for lumpectomy) also may prefer to have a mastectomy. And, mastectomy can offer some women peace of mind with less worry about recurrence.
However, differences in rates also can occur when women who are candidates for lumpectomy are not encouraged by their health care providers to have the procedure. Learning about your surgery options and talking with your provider about which treatments are best for you can help you feel confident that you are getting the best care possible. You should never hesitate to seek a second or even a third opinion from providers at different hospitals or practices.
Learn more about lumpectomy and mastectomy.
Learn more about getting good care.
References
1. Du X, Freeman JL, Freeman DH, et al. Temporal and regional variation in the use of breast-conserving surgery and radiotherapy for older women with early-stage breast cancer from 1983 to 1995. Journal of Gerontology: Medical Sciences. 54(9):M474-78, 1999.
2. Lazovich D, Solomon CC, Thomas DB, et al. Breast conservation therapy in the United States following the 1990 National Institutes of Health Consensus Development Conference on the Treatment of Patients with Early Stage Invasive Breast Carcinoma. Cancer. 86:628-37, 1999.
3. Wennberg JE and Cooper MM (eds.) The Dartmouth Atlas of Health Care 1998. American Hospital Publishing, Chicago, IL, 1998.
4. White J, Morrow M, Moughan J, et al. Compliance with breast-conservation standards for patients with early-stage breast carcinoma. Cancer. 97(4):893-904, 2003.
5. Smith GL, Xu Y, Shih YC, et al. Breast-conserving surgery in older patients with invasive breast cancer: current patterns of treatment across the United States. J Am Coll Surg. 209(4):425-433.e2, 2009.
Updated 01/23/12
