The unusual data release occurred because some drug company stock prices fluctuated suddenly in past years between the time ASCO members got copies of the abstracts and the time they were publicly released. Some of the research papers involve trials of cancer drugs. To prevent a repeat, ASCO decided to release nearly all of the material at once this year.
Mastectomy rates began to decline nationwide soon after a 1990 National Institutes of Health Consensus Panel reported that breast conservation surgery - lumpectomy plus radiation therapy - was as effective as mastectomy for overall survival of most women with early-stage breast cancer. There was some increased risk of cancer recurrence when a breast was left behind, the group said.
The medical community began to view high mastectomy rates as a negative, counting against hospital rating scores, with the implication that a center with high rates wasn't up on new techniques and treatments.
There was a sense that paternalistic doctors were encouraging women to undergo major surgery when it wasn't necessary. But Jacobs said she thinks today's return to mastectomies is about something else.
"Before, it was felt the physicians were pushing it," she said. "It's the patients pushing it now."
Jacobs and other physicians also cited a new feeling of empowerment on the part of patients - mixed with more available treatment information, genetic testing and better breast reconstruction surgery.
"People want to have their breast cancer treated and reduce the chances that they'll have to face it again," said Dr. Stephen Grobmyer, a surgical oncologist at the University of Florida's Shands Cancer Center in Gainesville. "We see patients every week that are very educated and in many cases know what they want: It's mastectomy."
Jacobs said she always explains all of the options to her patients. Whenever appropriate, she starts the conversation with, "You are a perfect candidate for lumpectomy."
But a patient's concerns may go beyond that. Many women who get mastectomies don't need chemotherapy or radiation, eliminating the side effects and hardships of five-day-a-week radiation for six weeks after a lumpectomy.
An MRI does help find more cancers - about 3 percent in one study. But it is also associated with a high number of false-positive results - 75 percent in another study.
