LUMPECTOMY OR MASTECTOMY - IS BREAST-CONSERVING SURGERY TOO EXPENSIVE

In the last decade, breast cancer patients have enjoyed an increase in breast conserving surgery (BCS). At present, modified radical mastect omy (MRM) and BCS offers equal expectations of survival. During the la st few years, however, a drop in the frequency of BCS has been reporte d by several authors. Is this new trend due to economic concerns? To c larify the costs of breast cancer therapy (stage I and II), we review the literature and include a cost-utility and a cost-minimisation anal ysis comparing MRM and BCS. The treatment cost (per patient) of BCS an d MRM in Norway was calculated at $9,564 and $5,596, respectively. Emp loying a quality of life gain in BCS of 0.03 (0-1 scale) and a 5% disc ount rate, the cost per QALY in BCS compared to MRM was $20,508. In co st-minimising analysis, BCS and mastectomy followed by reconstructive surgery had a cost of $10,748 and $8,538, respectively. This indicates that BCS remains within reasonable cost and should not be displaced b y mastectomy on economic grounds.