Introduction: During the last decade, our institution saw a 260% increase in bilateral breast reconstruction cases, consistent with national trends. We reported a drop in average age of prophylactic mastectomy from 57 to 51 years. There is limited data on the likelihood of histological abnormalities in this population. This study measures the prevalence of occult histological findings in prophylactic mastectomy patients. Given the current healthcare reform climate, we estimate the lifetime cost implications of prophylactic mastectomy with immediate reconstruction vs. surveillance. Methods: A retrospective database of breast reconstructions at the Massachusetts General Hospital was searched from 2004 to 2011 for prophylactic mastectomy patients. Breasts with prior biopsy-proven LCIS, DCIS, or cancer were excluded. Patient demographics, risk factors, and pathology reports were collected. Lifetime treatment reimbursements were estimated with 2013 rates from the Center for Medicare and Medicaid Services using Medicare billing codes. Reimbursements were estimated for 45-year-old patients undergoing contralateral prophylactic mastectomy and 40-year-old patients undergoing bilateral prophylactic mastectomies, and then were compared to women opting for surveillance. Conversion rates to cancer in these patients were used to estimate the percentage patients in the surveillance groups that would need therapeutic mastectomy. Sensitivity analyses were done to test the robustness of the models. Results: 495 prophylactic mastectomy specimens were identified, of which 2.0% had invasive cancer, 4.4% had ductal carcinoma in situ (DCIS), and 10.9% had lobular carcinoma in situ (LCIS) as the highest-risk lesion. Only age group was predictive of finding DCIS or cancer (P=0.02). The likelihood of finding LCIS, DCIS, or cancer increased with age group (P<0.001) and decreased with prior bilateral salpingo-oophorectomy (BSO)(P=0.02). In almost all scenarios, lifetime reimbursements were lower for pursuing either contralateral or bilateral prophylactic mastectomy, with immediate single-stage implant, expander, or abdominal perforator free flap (DIEP) reconstruction, as compared to surveillance. Conclusions: Prophylactic mastectomy patients have a significant rate of occult histological findings, increasing with age group and decreasing with prior BSO. Lifetime cost estimates suggest a cost-saving role in bilateral and contralateral prophylactic mastectomies. Ultimately, such a critical decision needs to be made individually, but should not be hindered by cost concerns. This study addresses a gap in knowledge with broad interest, contributing evidence of oncologic risk and cost to help guide decision-making in prophylactic mastectomy.

Made available in DSpace on 2014-12-17T14:19:40Z (GMT). No. of bitstreams: 1 JoselitoS.pdf: 612868 bytes, checksum: 0cc04efc92078741392b1c822ad08e6e (MD5) Previous issue date: 2007-05-25 / The breast cancer is the most incident neoplasia in Brazilian women, configure as important cause of female death in Brazil. Its magnitude is go to be consider as a disease that go out the biological and numerical, extending of the subjective dimension and interrelationships of society and socials experiences, to into in knowledge and practices. Linking of the growing older process, the breast cancer extend as social, economical and cultural dimensions, madding in plot of socials relationships, through that acquire mean. In the context of the high expectative of live and the high number of older age persons, consider that that the high number of years had lived correspond the exposition of this individuals to corporate of the ambientals aggressions and own processes of human constitution of natural wear, like as chronicle-degenerate disease, the example is cancer. In the perspective, we collected narratives of mastectomies women with 60 age or so, about the breast cancer, the body and the growing older process, had has as objectives to reflexes about relatives questions, the comprehension about cancer, like experience, had lived and mean in the context of action and interaction of mastectomies older women, and to comprehend like women interrelationships and respond the changes that grow up of the disease and the growing older process in the everyday of their lives. Through of the narratives. We know that the disease is an initial information that take a form through successives approximation between women with their reality, since the family from hospital institution. The breast cancer to be continue a disease who cause a lot of apprehension and fear, getting and changing the ill s live as marked form. Have dad the body and the growing older process genteels and redimensions by disease, women need to define news and multiples functions due to the contingency that the disease impose / O c?ncer de mama ? a neoplasia mais incidente nas mulheres brasileiras, configurando-se como importante causa de morte feminina, no Brasil. Sua magnitude leva-nos a consider?-lo uma doen?a que extrapola o puramente biol?gico e num?rico, estendendo-se ? dimens?o subjetiva e interrelacional, ao conv?vio e ?s experi?ncias sociais, adentrando num campo m?ltiplo de saberes e pr?ticas. Vinculando-se ao processo de envelhecimento, o c?ncer de mama alcan?a dimens?o social, econ?mica e cultural, e demarca percursos institucionais, individuais e coletivos, sendo socialmente constru?do na trama das rela??es sociais, atrav?s das quais adquire significado. Contextualizando o aumento da expectativa de vida e do n?mero de idosos, consideramos que os anos vividos a mais correspondem ? exposi??o dos indiv?duos a um conjunto de agressores ambientais e de processos pr?prios da constitui??o humana de desgaste natural, como as doen?as cr?nico-degenerativas, a exemplo do c?ncer. Nessa perspectiva, coletamos narrativas de mulheres mastectomizadas com 60 anos e mais, sobre o c?ncer de mama, o corpo e o envelhecimento, tendo como objetivos refletir sobre quest?es relativas ? compreens?o do c?ncer, como experi?ncia, vivida e significada em contextos de a??o e intera??o de mulheres idosas mastectomizadas; compreender como as mulheres se interrelacionam e reagem ?s modifica??es decorrentes da doen?a e do envelhecimento, no cotidiano de suas vidas. A partir das narrativas, compreendemos que a doen?a ? um dado inicial que toma forma a partir de sucessivas aproxima??es dessas mulheres da realidade que as cerca, desde a fam?lia at? a institui??o hospitalar. O c?ncer de mama continua sendo uma doen?a que causa muita apreens?o e medo, alcan?ando e modificando a vida da doente de forma marcante. Tendo o corpo e o envelhecimento afetados e redimensionados pela doen?a, as mulheres precisam definir novos e m?ltiplos pap?is sociais devido ?s conting?ncias que a doen?a lhes imp?e