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Growing Use of Contralateral Prophylactic Mastectomy Despite no Improvement in Long-term Survival for Invasive Breast Cancer

Wong, Stephanie M. MD; Freedman, Rachel A. MD, MPH; Sagara, Yasuaki MD; Aydogan, Fatih MD; Barry, William T. PhD; Golshan, Mehra MD

doi: 10.1097/SLA.0000000000001698
Original Articles

Objective: To update and examine national temporal trends in contralateral prophylactic mastectomy (CPM) and determine whether survival differed for invasive breast cancer patients based on hormone receptor (HR) status and age.

Methods: We identified women diagnosed with unilateral stage I to III breast cancer between 1998 and 2012 within the Surveillance, Epidemiology, and End Results registry. We compared characteristics and temporal trends between patients undergoing breast-conserving surgery, unilateral mastectomy, and CPM. We then performed Cox proportional-hazards regression to examine breast cancer-specific survival (BCSS) and overall survival (OS) in women diagnosed between 1998 and 2007, who underwent breast-conserving surgery with radiation (breast-conserving therapy), unilateral mastectomy, or CPM, with subsequent subgroup analysis stratifying by age and HR status.

Results: Of 496,488 women diagnosed with unilateral invasive breast cancer, 59.6% underwent breast-conserving surgery, 33.4% underwent unilateral mastectomy, and 7.0% underwent CPM. Overall, the proportion of women undergoing CPM increased from 3.9% in 2002 to 12.7% in 2012 (P < 0.001). Reconstructive surgery was performed in 48.3% of CPM patients compared with only 16.0% of unilateral mastectomy patients, with rates of reconstruction with CPM rising from 35.3% in 2002 to 55.4% in 2012 (P < 0.001). When compared with breast-conserving therapy, we found no significant improvement in BCSS or OS for women undergoing CPM (BCSS: HR 1.08, 95% confidence interval 1.01–1.16; OS: HR 1.08, 95% confidence interval 1.03–1.14), regardless of HR status or age.

Conclusions: The use of CPM more than tripled during the study period despite evidence suggesting no survival benefit over breast conservation. Further examination on how to optimally counsel women about surgical options is warranted.

*Harvard School of Public Health, Boston, MA

Department of Surgery, McGill University Health Centre, Montreal, QC, Canada

Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA

§Department of Surgery, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA

Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA.

Reprints: Dr Mehra Golshan, MD, Department of Surgery, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Ave, Boston, MA 02115. E-mail: mgolshan@partners.org..

Results of this manuscript will be presented, in part, at the 2016 Society of Surgical Oncology Annual Meeting, Boston, MA.

Disclaimers: RAF acknowledges institutional funding from Genentech and Puma for studies unrelated to the current work, and does not receive any salary support from these sources. The remaining authors have no relevant conflicts of interest to disclose.

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