Immediate breast reconstruction for women having inflammatory breast cancer in the United States

• Published in: Cancer medicine (Malden, MA) MA), 2018-07, Vol.7 (7), p.2887-2902
• Main Authors: Patel, Sameer A., Ng, Marilyn, Nardello, Salvatore M., Ruth, Karen, Bleicher, Richard J.
• Format: Article
• Language: English
• Subjects: Breast cancer; breast neoplasms; Clinical Cancer Research; Inflammation; inflammatory breast neoplasms; Lymph nodes; Malignancy; Mastectomy; Medical prognosis; Menopause; Mortality; Original Research; patient safety; Population studies; practice guideline; reconstructive surgical procedures
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.1546

Inflammatory breast cancer (IBC) is an aggressive malignancy having a poor prognosis. Traditionally, reconstruction is not offered due to concerns about treatment delay, margin positivity, recurrence, and poor long‐term survival. There is a paucity of literature, however, evaluating whether immediate breast reconstruction (IBR) is associated with greater mortality in patients with IBC. A population‐based study was conducted via the SEER‐Medicare‐linked database (1991‐2009). Female patients greater than 65 years were reviewed who had mastectomy and reconstruction claims for nonmetastatic IBC. Competing risk and Cox regression were used to assess whether IBR was associated with higher breast cancer‐specific mortality (BCSM) or overall mortality (OM). Among 552 936 patients, 1472 (median age 74 years) were diagnosed with IBC and had a mastectomy. Forty‐four patients (3%) underwent IBR. Younger age, a lower Charlson comorbidity score, and a greater median income were predictors of IBR use. Tumor grade, hormone receptor status, and lymph node status were independent predictors of adjusted OM and BCSM. There was no difference by IBR status in BCSM or covariate‐adjusted BCSM (sHR 1.04; CI 0.71‐1.54; P = .83 and sHR 1.13; CI 0.84‐1.93; P = .58, respectively). Cumulative incidence of OM was lower among IR patients (P = .013), and IR did not influence the cumulative incidence of BCSM (P = .91). IBR was not associated with increased overall and BCSM mortality. Although further study of IBR in the IBC setting may be of value, these data suggest that IBC should not be considered an absolute contraindication to IBR. Recent adoption of multimodality treatment has improved survival among inflammatory breast cancer patients. Our analysis of the SEER‐Medicare national dataset suggests that immediate breast reconstruction is a safe option in select patients.