Breast Cancer Research and Treatment

, Volume 142, Issue 3, pp 465–476 | Cite as

Contralateral prophylactic mastectomy and survival: report from the National Cancer Data Base, 1998–2002

  • Katharine Yao
  • David J. Winchester
  • Tomasz Czechura
  • Dezheng Huo


The use of contralateral prophylactic mastectomy (CPM) has been increasing despite questionable survival benefit. We examined the effect of CPM on survival using the National Cancer Data Base. We examined overall survival on 219,983 mastectomy patients diagnosed with unilateral AJCC Stage 1–III invasive breast cancer between 1998 and 2002 of which 14,994 (7 %) underwent CPM at the time of their index mastectomy. Median follow up time was 5 years. Neoadjuvant and locally advanced breast cancers were excluded. Approximately 4 % underwent CPM in 1998 compared to 9.4 % in 2002, an ~125 % increase. CPM patients were significantly younger than non-CPM patients, on managed care plans, and were treated at high volume centers. The unadjusted hazard ratio (HR) of death was 0.55 (95 % CI 0.52–0.57) for CPM compared to unilateral mastectomy. In a multivariable Cox model adjusting for age, race, stage, grade, histology, insurance, facility characteristics, use of adjuvant hormonal, chemotherapy, and radiotherapy, and year of diagnosis, the adjusted HR was 0.88 (95 % CI 0.83–0.93; p < 0.001) which translated into an absolute 5-year benefit of 2 %. There was a differential effect of CPM by stage and age: HR = 0.88 (95 % CI 0.82–0.94; p < 0.001) in women younger than 70 with stage I/II, and HR = 0.95 (95 % CI 0.88–1.04; p = 0.28) in women with stage III or older than age 69 which translated into an absolute 5-year benefit of 1.3 %. Utilization of hormonal therapy or chemotherapy had no effect on the HR. After adjusting for confounding, the overall survival benefit for CPM is minimal at best.


Contralateral prophylactic mastectomy (CPM) Survival National Cancer Data Base Bilateral mastectomy survival Double mastectomy survival 


  1. 1.
    Tuttle T, Havermann EB, Grund EH, Morris TJ, Virnig B (2007) Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol 25(33):5203–5209PubMedCrossRefGoogle Scholar
  2. 2.
    Tuttle T, Jarosek S, Habermann EB, Arrington A, Abraham A, Morris TJ, Virnig BA (2009) Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol 27(9):1362–1367PubMedCrossRefGoogle Scholar
  3. 3.
    Yao K, Stewart A, Winchester DJ, Winchester DP (2010) Trends in contralateral prophylactic mastectomy for unilateral cancer: a report from the National Cancer Data Base, 1998–2007. Ann Surg Oncol 17:2554–2562PubMedCrossRefGoogle Scholar
  4. 4.
    Katipamula R, Degnim AC, Hoskin T, Boughey JC, Loprinzi C, Grant CS, Brandt KR et al (2009) Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol 27(25):4082–4088PubMedCrossRefGoogle Scholar
  5. 5.
    King TA, Sakr R, Patil S et al (2011) Clinical management factors contribute to the decision for contralateral prophylactic mastectomy. J Clin Oncol 29:2158–2164PubMedCrossRefGoogle Scholar
  6. 6.
    Goldflam K, Hunt KK, Gershenwald JE et al (2004) Contralateral prophylactic mastectomy. Predictors of significant histologic findings. Cancer 101(9):1977–1986PubMedCrossRefGoogle Scholar
  7. 7.
    Lee JSGC, Donohue JD et al (1995) Arguments against routine contralateral mastectomy or undirected biopsy for invasive lobular breast cancer. Surgery 118:640–648PubMedCrossRefGoogle Scholar
  8. 8.
    Peralta EAEJ, Wagman LD et al (2000) Contralateral prophylactic mastectomy improves the outcome of selected patients undergoing mastectomy for breast cancer. Am J Surg 180:439–445PubMedCrossRefGoogle Scholar
  9. 9.
    Herrinton LJBW, Yu O, Geiger AM, Elmore JG, Barton MB, Harris EL et al (2005) Efficacy of prophylactic mastectomy in women with unilateral breast cancer: a cancer research network project. J Clin Oncol 23(19):4275–4286PubMedCrossRefGoogle Scholar
  10. 10.
    Bedrosian I, Hu CY, Chang GJ (2010) Population-based study of contralateral prophylactic mastectomy and survival outcomes of breast cancer patients. J Natl Cancer Inst 102:1–9CrossRefGoogle Scholar
  11. 11.
    Boughey J, Hoskin TL, Degnim AC et al (2010) Contralateral prophylactic mastectomy is associated with a survival advantage in high risk women with a personal history of breast cancer. Ann Surg Oncol 17:2702–2709PubMedCrossRefGoogle Scholar
  12. 12.
    Bilimoria K, Bentrem DJ, Winchester DP, Stewart AK, Ko CY (2009) Comparison of commission on cancer approved and non-approved hospitals in the United States: implications for studies that use the National Cancer Data Base. J Clin Oncol 27(25):4177–4181PubMedCrossRefGoogle Scholar
  13. 13.
    Brewster A, Bedrosian I, Parker PA, Dong W et al (2012) Association between contralateral prophylactic mastectomy and breast cancer outcomes by hormone receptor status. Cancer 118(22):5637–5643PubMedCrossRefGoogle Scholar
  14. 14.
    Lostumbo L, Carbine N, Wallace J et al (2004) Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev 4:CD002748PubMedGoogle Scholar
  15. 15.
    Bilimoria K, Bentrem DJ, Winchester DP, Stewart AK, Ko CY (2008) The National Cancer Data Base: a powerful initiative to improve cancer care in America. Ann Surg Oncol 15(3):683–690PubMedCrossRefGoogle Scholar
  16. 16.
    U.S. Census Bureau USC (2000). Accessed 15 April 2013
  17. 17.
    Greene FL (2002) AJCC cancer staging manual. Springer-Verlag, New YorkCrossRefGoogle Scholar
  18. 18.
    Chung A, Huynh K, Lawrence C, Sims MS, Giuliano A et al (2012) Comparison of patient characteristics and outcomes of contralateral prophylactic mastectomy and unilateral total mastectomy in breast cancer patients. Ann Surg Oncol 19(8):2600–2606PubMedCrossRefGoogle Scholar
  19. 19.
    Babiera G, Lowy AM, Davidson BS, Singletary SE (2007) The role of contralateral prophylactic mastectomy in invasive lobular carcinoma. Breast J 3(1):2–6CrossRefGoogle Scholar
  20. 20.
    Tuttle T, Habermann EB, Virnig B (2010) Re: population-based study of contralateral prophylactic mastectomy and survival outcomes of breast cancer patients. J Natl Caner Inst 102(17):1371–1372CrossRefGoogle Scholar
  21. 21.
    Fisher BAS, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH et al (2002) Twenty year follow up of a randomized trial comparing total mastectomy, lumpectomy and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241PubMedCrossRefGoogle Scholar
  22. 22.
    Gao X, Fisher SG, Emami B (2003) Risk of second primary cancer in the contralateral breast in women treated for early-stage breast cancer: a population-based study. Int J Radiat Oncol Biol Phys 56(4):1038–1045PubMedCrossRefGoogle Scholar
  23. 23.
    Fisher B, Jeong JH, Bryant J, Anderson S et al (2004) Treatment of lymph-node-negative, oestrogen-receptor-positive breast cancer: long-term findings from national surgical adjuvant breast and bowel project randomised clinical trials. Lancet 4(364):858–868CrossRefGoogle Scholar
  24. 24.
    Fisher B, Land S, Mamounas E et al (2001) Prevention of invasive breast cancer in women with ductal carcinoma in situ: an update of the national surgical adjuvant breast and bowel project experience. Semin Oncol 28(4):400–418PubMedCrossRefGoogle Scholar
  25. 25.
    Cuzick J, Sestak I, Baum M, Buzdar A et al (2010) Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 10-year analysis of the ATAC trial. Lancet Oncol 11(12):1135–1141PubMedCrossRefGoogle Scholar
  26. 26.
    Early Breast Cancer Trialists’ Collaborative Group (1998) Polychemotherapy for early breast cancer: an overview of the randomized trials. Lancet 352:930–942CrossRefGoogle Scholar
  27. 27.
    Houssami N, Ciatto S, Martinelli F, Bonardi R, Duffy SW (2009) Early detection of second breast cancers improves prognosis in breast cancer survivors. Ann Oncol 9:1505–1520CrossRefGoogle Scholar
  28. 28.
    Narod SA (2011) The impact of contralateral mastectomy on mortality in BRCA1 and BRCA2 mutation carriers with breast cancer. Breast Cancer Res Treat 128:581–583PubMedCrossRefGoogle Scholar
  29. 29.
    Bernstein J, Lapinski RH, Thakore SS, Doucette JT, Thompson WD (2003) The descriptive epidemiology of second primary breast cancer. Epidemiology 14(5):552–558PubMedCrossRefGoogle Scholar
  30. 30.
    Reiner A, John EM, Brooks JD, Lynch CF, Bernstein L, Mellemkjaer L, Malone KE, Knight JA, Capanu M, Teraoka SN, Concannon P, Liang X, Figueiredo JC, Smith SA, Stovall M, Pike MC, Haile RW, Thomas DC, Begg CB, Bernstein JL (2010) Risk of asynchronous contralateral breast cancer in noncarriers of BRCA1 and BRCA2 mutations with a family history of breast cancer: a report from the women’s environmental cancer and radiation epidemiology study. J Clin Oncol 31:433–439CrossRefGoogle Scholar
  31. 31.
    Rhiem K, Engel C, Graeser M et al (2012) The risk of contralateral breast cancer in patients from BRCA1/2 negative high risk families as compared to patients from BRCA1 or BRCA2 positive families: a retrospective cohort study. Breast Cancer Res 14:R156PubMedCrossRefGoogle Scholar
  32. 32.
    Pierce L, Levin AM, Rebbeck TR et al (2006) Ten-year multi-institutional results of breast-conserving surgery and radiotherapy in BRCA1/2-associated stage I/II breast cancer. J Clin Oncol 24(16):2437–2443PubMedCrossRefGoogle Scholar
  33. 33.
    Mavaddat N, Barrowdale D, Andrulis IL et al (2012) Pathology of breast and ovarian cancer among BRCA1 and BRCA2 mutation carriers: results from the Consortium of Investigators of Modifiers of BRCA1/2. Cancer Epidemiol Biomarkers Prev 21(1):134–147PubMedCrossRefGoogle Scholar
  34. 34.
    Chen S, Parmigiani G (2007) Meta-analysis of BRCA1 and BRCA2 penetrance. J Clin Oncol 25(11):1329–1333PubMedCrossRefGoogle Scholar
  35. 35.
    Rebbeck TF, Lynch HT et al (2004) Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol 22(6):1055–1062PubMedCrossRefGoogle Scholar
  36. 36.
    Heemskerk-Gerritsen B, Menke-Pluymers MBE et al (2007) Prophylactic mastectomy in BRCA 1/2 mutation carriers and women at risk of hereditary breast cancer: long-term experiences at the Rotterdam Family Cancer Clinic. Ann Surg Oncol 14(12):3335–3344PubMedCrossRefGoogle Scholar
  37. 37.
    Hartman L, Woods JE (1999) Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med 340:77–84CrossRefGoogle Scholar
  38. 38.
    Robinson E, Rennert G, Rennert HS et al (2006) Survival of first and second primary breast cancer. Cancer 71(1):172–176CrossRefGoogle Scholar
  39. 39.
    Schaapveld M, Visser O, Louwman WJ et al (2008) The impact of adjuvant therapy on contralateral breast cancer risk and the prognostic significance of contralateral breast cancer: a population based study in the Netherlands. Breast Cancer Res Treat 110(1):189–197PubMedCrossRefGoogle Scholar
  40. 40.
    Hartman M, Czene K, Reilly M, Adolfsson J et al (2007) Incidence and prognosis of synchronous and metachronous bilateral breast cancer. J Clin Oncol 25:4210–4216PubMedCrossRefGoogle Scholar
  41. 41.
    Vichapat V, Garmo H, Holmqvist M et al (2012) Tumor stage affects risk and prognosis of contralateral breast cancer: results from a large Swedish-population-based study. J Clin Oncol 30:3478–3485 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Katharine Yao
    • 1
  • David J. Winchester
    • 1
  • Tomasz Czechura
    • 1
  • Dezheng Huo
    • 2
  1. 1.Department of SurgeryNorthShore University HealthSystemEvanstonUSA
  2. 2.Department of Health StudiesUniversity of ChicagoChicagoUSA

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