Medical contraindications are not a major factor in the underutilization of breast conserving therapy

Background: Multiple randomized trials have demonstrated that survival after breast conserving therapy (BCT) is equal to survival after mastectomy, but large population-based studies indicate that > 50% of patients with early stage breast cancer continue to undergo mastectomy. This study was undertaken to determine whether medical contraindications to BCT or patient choice are responsible for high mastectomy rates. Study Design: Four hundred thirty-two patients with stage 0, I, or II breast carcinoma were prospectively evaluated by a multidisciplinary team for eligibility for BCT. Standard criteria developed by a joint committee of the American College of Surgeons, American College of Radiologists, College of American Pathologists, and Society of Surgical Oncology were used. Eligible patients were offered a choice among BCT, mastectomy, or mastectomy and immediate reconstruction. Results: Only 97 of the 432 patients had contraindications to BCT. The incidence of contraindications varied by stage: 10% for stage I, 28% for stage II, and 33% for stage 0 (p < 0.01). The type of contraindications also varied with stage. Age, histologic tumor type, and axillary node status (when controlled for tumor size) did not influence rates of BCT. Of eligible patients, 81% chose BCT, independent of age or race. Conclusions: Medical contraindications to BCT are not major factors resulting in high mastectomy rates. Strategies like neoadjuvant chemotherapy, which addresses medical contraindications, are unlikely to have a major impact on national rates of BCT.