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Trends in the use of bilateral mastectomy in England from 2002 to 2011: retrospective analysis of hospital episode statistics
  1. Jenny Neuburger1,2,
  2. Fiona MacNeill3,
  3. Ranjeet Jeevan2,4,
  4. Jan H P van der Meulen1,2,
  5. David A Cromwell1,2
  1. 1Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
  2. 2Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
  3. 3The Royal Marsden, The Royal Marsden NHS Foundation Trust, London, UK
  4. 4Whiston Hospital, St Helens & Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK
  1. Correspondence to Dr Jenny Neuburger; Jenny.Neuburger{at}


Objectives For healthy women at high risk of developing breast cancer, a bilateral mastectomy can reduce future risk. For women who already have unilateral breast cancer, removing the contralateral healthy breast is more difficult to justify. We examined trends in the number of women who had a bilateral mastectomy in England between 2002 and 2011.

Design Retrospective cohort study using the Hospital Episode Statistics database.

Setting NHS hospital trusts in England.

Participants Women aged between 18 and 80 years who had a bilateral mastectomy (or a contralateral mastectomy within 24 months of unilateral mastectomy) with or without a diagnosis of breast cancer.

Main outcome measures Number and incidence of women without breast cancer who had a bilateral mastectomy; number and proportion who had a bilateral mastectomy as their first breast cancer operation, and the proportion of those undergoing bilateral mastectomy who had immediate breast reconstruction.

Results Among women without breast cancer, the number who had a bilateral mastectomy increased from 71 in 2002 to 255 in 2011 (annual incidence rate ratio 1.16, 95% CI 1.13 to 1.18). In women with breast cancer, the number rose from 529 to 931, an increase from 2% to 3.1% of first operations (OR for annual increase 1.07, 95% CI 1.05 to 1.08). Across both groups, rates of immediate breast reconstruction roughly doubled and reached 90% among women without breast cancer in 2011.

Conclusions The number of women who had a bilateral mastectomy nearly doubled over the last decade, and more than tripled among women without breast cancer. This coincided with an increase in the use of immediate breast reconstruction.

  • Oncology
  • Preventive Medicine
  • Plastic & Reconstructive Surgery

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