Which Surgery for Early-Stage Breast Cancer Is Most Cost-Effective?

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When a woman is diagnosed with early-stage breast cancer, she and her doctor have a number of surgical options to remove the cancer:

  • lumpectomy plus whole-breast radiation
  • lumpectomy plus partial-breast radiation, which is also called brachytherapy
  • mastectomy alone
  • mastectomy plus reconstruction
  • older women also may choose to have lumpectomy alone

Researchers wanted to compare the complications related to each treatment as well as the cost of each treatment to determine its relative value.

A study suggests that mastectomy followed by reconstruction causes more complications and costs more than the other surgery options for early-stage disease.

While the results might suggest that mastectomy followed by reconstruction isn’t the best option, it’s important to remember that this study looked only at the complications and costs of the procedures. The researchers did not take into account any of the characteristics of the cancer: hormone-receptor status, lymph node status, HER2 status, etc. The study also didn’t take into account a woman’s family history of breast cancer, any other health conditions she may have had, whether she had had radiation to the chest as a child, or her personal preferences.

The research was published in the April 12, 2017 issue of the Journal of the National Cancer Institute. Read the abstract of “Cost and Complications of Local Therapies for Early-Stage Breast Cancer.”

To do the study, the researchers looked at a MarketScan database of younger women with private health insurance and the SEER Medicare database of older women with public health insurance. The SEER database is a large registry of cancer cases from sources throughout the United States maintained by the National Institutes of Health. The MarketScan database is maintained by Truven Health Analytics and contains hospital and doctor insurance claims information.

The researchers found 105,211 women who were diagnosed with early-stage breast cancer between 2000 and 2011. Using the treatment claim codes, the researchers figured out which type of treatment each woman had, as well as any complications related to that treatment. The cost of the treatment and any complications were calculated by what was paid for by insurance.

The researchers found:

  • lumpectomy plus whole-breast radiation was the most common treatment
  • mastectomy plus reconstruction had nearly twice the risk of complications compared to lumpectomy plus whole-breast radiation
    • younger women had a 54.3% risk of complications from mastectomy plus reconstruction compared to a 29.6% risk of complications from lumpectomy plus whole-breast radiation
    • older women had a 66.1% risk of complications from mastectomy plus reconstruction compared to a 37.6% risk of complications from lumpectomy plus whole-breast radiation
  • mastectomy plus reconstruction cost an average of $22,481 more than lumpectomy plus whole-breast radiation for younger women and an average of $1,748 more for older women
  • complication-related costs were an average of $9,017 more for mastectomy plus reconstruction than lumpectomy plus whole-breast radiation for younger women and an average of $2,092 more for older women
  • lumpectomy plus partial-breast radiation cost slightly more and had slightly more complications than lumpectomy plus whole-breast radiation
  • lumpectomy alone cost less and caused fewer complications than the other treatments, but only for older women

"We believe that this research is helpful to frame the conversation between a woman and her physicians regarding the trade-offs between lumpectomy with whole-breast irradiation and mastectomy with reconstruction," said the paper's lead author, Benjamin Smith, associate professor of radiation oncology at the University of Texas MD Anderson Cancer Center. "While mastectomy with reconstruction is sometimes the best treatment for an individual patient, it is important for patients to understand the potential for complications, some of which can be quite significant."

When you’re first diagnosed with breast cancer, fears about the future can affect how you make decisions. This is especially true for women who have an abnormal breast cancer gene or who have watched a mother or sister be diagnosed with breast cancer. You have to make a number of decisions at a very emotional time when it can be hard to absorb and understand all the new information you’re being given.

At Breastcancer.org, we support every woman’s right to make treatment decisions based on the characteristics of the cancer she’s been diagnosed with, her medical history, her risk of recurrence or a new breast cancer, and her personal preferences. But it’s very important to make sure you understand all the pros and cons of any treatment or procedure you’re considering, including how the treatment or procedure may affect your reconstruction options and if the treatment is likely to make you live longer.

If you’ve been diagnosed with early-stage breast cancer, ask your doctor about ALL of your treatment and risk reduction options. Give yourself the time you need to consider the decision carefully. It’s a good idea to talk to your doctor about how the details in your pathology report may affect your future risk. You want to be sure that your decisions are based on your actual risk of recurrence or a new cancer. Make sure you understand the benefits and risks of all your options. Together, you and your doctor can make the choices that are best for you and your unique situation.

For more information, visit the Breastcancer.org Surgery section.



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