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Trend and survival benefit of contralateral prophylactic mastectomy among men with stage I–III unilateral breast cancer in the USA, 1998–2016

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Our study aimed to explore temporal trends and survival benefit of contralateral prophylactic mastectomy (CPM) in male breast cancer (MBC).

Methods

Men with stage I–III unilateral breast cancer between 1998 and 2016 were identified from the surveillance, epidemiology, and end results (SEER). We compared CPM rate over the study period using the Cochrane-Armitage test for trend. Logistic regression model was used to test for factors predicting CPM. Survival analysis was conducted in patients who underwent CPM or unilateral mastectomy (UM) with a first diagnosis of unilateral breast cancer. Kaplan–Meier curve and univariate and multivariable Cox proportional hazards regression analyses were performed to compare overall survival (OS) and breast cancer-specific survival (BCSS) between CPM and UM groups. Propensity score matching was adopted to balance baseline characteristics.

Results

5118 MBC cases were included in the present study, with 4.1% (n = 209) patients underwent CPM. The proportion of men undergoing CPM increased from 1.7 in 1998 to 6.3% in 2016 (P < 0.0001). Young age, recent years of diagnosis, higher tumor grade and lower T stage were significantly associated with CPM. A cohort of 3566 patients were enrolled in survival analysis with a median follow-up of 65 months. CPM was associated with better OS (HR 0.58, 95% CI 0.37–0.89, P = 0.022) rather than BCSS (HR 0.57, 95% CI 0.29–1.11, P = 0.153) compared with UM. In propensity score-matched model, CPM was not an independent prognostic factor for OS (HR 0.83, 95% CI 0.46–1.52, P = 0.553) and BCSS (HR 0.98, 95% CI 0.39–2.47, P = 0.970).

Conclusion

Our study revealed a dramatic increase in CPM utilization among MBC, especially in young patients. However, CPM provides no survival benefit for MBC compared with UM, indicating the decision of CPM should be fully discussed.

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Acknowledgements

We are thankful the Surveillance, Epidemiology, and End Results Program (National Cancer Institute) for the development of the SEER database.

Funding

None.

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Author notes

  1. Yinlong Yang and Liangwei Pan have contributed equally to this work.

Authors and Affiliations

  1. Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200000, China

    Yinlong Yang, Liangwei Pan & Zhiming Shao

  2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200000, China

    Yinlong Yang, Liangwei Pan & Zhiming Shao

  3. Eight-Year Program Clinical Medicine, Grade of 2016, Shanghai Medical College, Fudan University, Shanghai, China

    Liangwei Pan

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Contributions

YY and ZS had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. YY and LP contributed equally as co–first authors. YY and ZS contributed equally as co–senior authors. Concept and design: YY, ZS. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: YY, LP. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: All authors. Supervision: YY.

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Correspondence to Yinlong Yang.

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Yang, Y., Pan, L. & Shao, Z. Trend and survival benefit of contralateral prophylactic mastectomy among men with stage I–III unilateral breast cancer in the USA, 1998–2016. Breast Cancer Res Treat 190, 503–515 (2021). https://doi.org/10.1007/s10549-021-06397-z

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