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Contralateral Prophylactic Mastectomy Use After Neoadjuvant Chemotherapy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neoadjuvant chemotherapy (NAC) for breast cancer increases breast-conserving surgery (BCS) rates, but many women opt for mastectomy with contralateral prophylactic mastectomy (CPM). Here we evaluate factors associated with CPM use in women undergoing mastectomy post-NAC.

Methods

A retrospective institutional NAC database review identified women with clinical stage I-III, unilateral invasive breast cancer undergoing unilateral mastectomy (UM) or CPM mastectomy from 9/2013 to 12/2017. Clinical/pathologic characteristics, imaging, and presence of contraindications to BCS post-NAC were compared, with subset analysis of BCS candidates. The multivariable analysis was adjusted for potential confounders.

Results

Five hundred sixty-nine women underwent mastectomy after NAC, 297 (52%) UM and 272 (48%) CPM. On univariable analysis, younger age, BRCA+, lower pre-NAC clinical stage, pathologic complete response, and axillary surgery extent were associated with CPM (all p < 0.01). Favorable post-NAC clinical factors of no residual palpable disease, clinically negative nodes, complete response on breast imaging, and no post-NAC contraindication to BCS were also associated with CPM (all p < 0.01). On multivariable analysis, young age (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.91–0.95), lower pre-NAC stage (OR 0.51, 95% CI 0.34–0.77), and no contraindication to BCS (OR 3.12, 95% CI 2.02–4.82) were significantly associated with CPM. Among the 203 (35%) women who had no contraindications to BCS post-NAC, 145 (71%) underwent CPM. BRCA+ and family history were reasons more frequently cited for mastectomy among CPM than UM (p < 0.001).

Conclusions

CPM was performed in 48% of women undergoing mastectomy after NAC; younger women with earlier-stage cancers were more likely to undergo CPM. While increased use of CPM in women with more favorable disease is medically appropriate, our findings indicate a lost opportunity for use of BCS.

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Acknowledgements

This study was presented in poster format at the Society of Surgical Oncology 72nd Annual Cancer Symposium, March 27–30, 2019, San Diego, CA.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA

    Nicole Christian MD, MS, Michael Cassidy MD, Monica Morrow MD & Mary L. Gemignani MD, MPH

  2. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Emily C. Zabor DrPH & Jessica Flynn BS

Authors
  1. Nicole Christian MD, MS
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  2. Emily C. Zabor DrPH
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  3. Michael Cassidy MD
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  4. Jessica Flynn BS
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  5. Monica Morrow MD
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  6. Mary L. Gemignani MD, MPH
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Corresponding author

Correspondence to Mary L. Gemignani MD, MPH.

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Disclosures

The preparation of this manuscript was funded in part by NIH/NCI Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center, Dr. Monica Morrow has received speaking honoraria from Genomic Health and Roche.

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Christian, N., Zabor, E.C., Cassidy, M. et al. Contralateral Prophylactic Mastectomy Use After Neoadjuvant Chemotherapy. Ann Surg Oncol 27, 743–749 (2020). https://doi.org/10.1245/s10434-019-08038-8

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  • DOI: https://doi.org/10.1245/s10434-019-08038-8

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