Chemo brain.

Neoadjuvant chemo (NAC) is increasingly utilized among women with breast cancer due to the prognostic information that can be derived from treatment response. Interestingly, the receipt of NAC may be influencing more than that. Results of a national cancer database (NCDB) study reported in the Annals of Surgical Oncology last week showed that women who received NAC versus adjuvant chemo are 50% more likely to have bilateral mastectomies. We know what you might be thinking: aren’t the worst tumors the ones that get NAC? But these results were independent of nodal status, pathologic response, or histological subtype. More surprisingly, this effect was larger as tumors got smaller. Among women with clinical T1 tumors, 32% of those receiving NAC had bilateral mastectomies compared to 13% for those receiving AC. We don’t know how to explain it, so hopefully some of you will look into how NAC influences the surgical decision making process of women with early stage breast cancer. And be sure to let us know when you figure it out.