Many women with early stage breast cancer consider local therapy, namely mastectomy plus breast reconstruction. However, new data presented during this year’s 2015 San Antonio Breast Cancer Symposium, now through Dec. 12, finds certain therapies place higher costs and overall burden on women.

Researchers report this therapy has the highest complication rates and complication-related costs for both younger women with private insurance and older women on Medicare. For young women, this is the most expensive therapy option out of the several that are available. After mastectomy and reconstruction (without radiation) there's lumpectomy plus whole breast irradiation (WBI), lumpectomy plus brachytherapy, mastectomy without reconstruction or radiation, and lumpectomy without radiation.

"Although there's nuance as far as what treatment is best for which patient, there is a large group of patients for whom most, if not all, of these treatment options are considered guideline-appropriate," said lead study author Dr. Benjamin D. Smith, associate professor and research director of the breast radiation oncology section at the University of Texas MD Anderson Cancer Center in Houston, in a press release.

Smith added there isn't a framework to help patients understand what it’s like to undergo mastectomy and reconstruction compared to, say, lumpectomy and WBI, such as the side effects and cost to both patient and patient's insurance company.

"To me, it seemed like a black box," he said. "Mastectomy and reconstruction rates have been increasing in the United States in the past decade, and I think ours is the first study to quantify the harm associated with choosing this procedure as opposed to simpler options."

The study analyzed data from the MarketScan database, which includes younger women with private insurance, as well as the SEER-Medicare database, which includes older women with Medicare, from 2000 through 2011. Both younger and older women were considered if they were diagnosed with early stage breast cancer, had no prior concern, and were completely insured from 12 months up to two years after diagnosis.

For the purpose of the study, local therapy complications included wound complication, local infection, breast pain, rib fracture, implant removal, and graft failure. Researchers then calculated total costs and complication-related costs "from a payer's perspective and were reported in 2014 dollars." In the end, they used data from 44,344 younger women and over 60,000 older women a median age of 53 and 75, respectively.

Young women were 30 percent for lumpectomy and WBI, 45 percent for lumpectomy and brachytherapy, 25 percent for mastectomy alone, and 31 percent for lumpectomy alone. Older women, on the other hand, were 38 percent for lumpectomy and WBI, 37 percent for mastectomy alone, 69 percent for mastectomy and reconstruction, and 31 percent for mastectomy alone.

Risk of complications from mastectomy plus reconstruction was two times higher than lumpectomy and WBI for both younger and older women, and it remained so after researchers adjusted for other differences in ways patients were treated. The complication-related costs came out to be $8,608 higher for younger women with private insurance and $2,568 higher for older women.

Researchers concluded "these findings are relevant to defining which local therapies offer the highest value to patients, payers, and society."

"When oncologists offer all appropriate therapy options to patients, some women may choose to avoid radiation and opt for mastectomy and reconstruction instead," Smith said. "This study is helpful to such patients because it provides them with information regarding the trade-offs involved in this choice."

Source: Smith BD et al. Complication and economic burden of local therapy options for early breast cancer. San Antonio Breast Cancer Symposium. 2015.