Breast cancer treatments vary widely in cost and complications

A microscopic image of a poorly differentiated, grade 3, infiltrating (invasive) ductal carcinoma. (iStock)

Women with early-stage breast cancer may have fewer treatment complications and lower costs when they don't get a mastectomy followed by reconstructive surgery, a U.S. study suggests.

In recent years, reconstruction following a mastectomy has become more widely available, contributing to a sharp increase in the number of women who opt for this treatment even when less aggressive alternatives may be just as effective, researchers note in the Journal of the National Cancer Institute.

With early-stage tumors that haven't spread to distant parts of the body, survival odds are similar for a mastectomy or a lumpectomy paired with radiation, previous studies have found.

In the current study, researchers found the risk of complications with a mastectomy followed by reconstruction was almost twice that of lumpectomy.

"The vast majority of women with early breast cancer can undergo breast conserving therapy followed by whole breast irradiation which allows for preservation of the breast," said lead study author Dr. Benjamin Smith, a researcher at the University of Texas MD Anderson Cancer Center in Houston.

"Our data illuminate that this treatment strategy may very well be easier on patients from a complication perspective and still allow them to preserve their body image," Smith added by email.

Most of these patients have surgery - either a lumpectomy that removes malignant tissue while sparing the rest of the breast or a mastectomy that removes the entire breast. After surgery, they may also get chemotherapy or radiation to destroy any remaining abnormal cells and reduce the risk of cancer coming back.

To assess complications and costs, researchers analyzed data on patients diagnosed from 2000 to 2011. The study included 44,344 women under 65 with employer-based health insurance and 60,867 women at least 66 years old with coverage through Medicare.

Researchers looked for complications such as infections, fluid buildup, blood clots, lumps of dead tissue or pain in the breast, inflammation in the lungs, rib fractures, implant removals or graft failures.

After two years, 30 percent of the younger women experienced complications with a lumpectomy followed by whole breast radiation, compared with 54 percent among those who underwent mastectomy paired with reconstruction. With a mastectomy alone, the complication rate was 25 percent.

For older women, 38 percent had complications with a lumpectomy and radiation, compared with 66 percent for a mastectomy and reconstruction and 37 percent for a mastectomy alone.

Compared to the lumpectomy and radiation, complication costs were roughly $9,000 higher for the younger women who got a mastectomy with reconstruction and $2,000 higher for the older women.

Within two years of diagnosis, the total cost of treatment with a mastectomy plus reconstructive surgery was $88,000 for the younger women, $22,000 more expensive than a lumpectomy with whole breast radiation. In the older group, the mastectomy with reconstruction was $36,000, which was $2,000 more than the lumpectomy and whole breast radiation.

One limitation of the study is that the costs come from just 2010 and 2011, the authors note. Because insurance coverage varies, the study doesn't show what individual patients may pay out-of-pocket for their care.

Doctors may recommend a mastectomy when cancer cells remain after a lumpectomy, or for women who want to avoid radiation or repeated mammograms, Smith noted.

"Not all patients are eligible for breast conserving surgery; for patients requiring a mastectomy, reconstruction allows women to have a breast mound which may be important to them," Anees Chagpar, director of the breast center at Smilow Cancer Hospital at Yale-New Haven in Connecticut, said by email. Chagpar wasn't involved in the study.

Early stage breast cancer also includes a lot of women with very different situations, noted Dr. Lisa Schneider, a plastic surgeon at the Institute for Advanced Reconstruction in Shrewsbury, New Jersey, who wasn't involved in the study.

"Someone with a strong family predisposition who is deeply fearful of breast cancer and has seen their mother die of cancer may make a very different choice than someone who has young children . . . or an elderly parent they need to care for and needs to get back to work as soon as possible," Schneider said by email.