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The use of contralateral prophylactic mastectomy among elderly patients in the United States

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

Abstract

Purpose

Previous studies have reported increased rates of contralateral prophylactic mastectomy (CPM) in the United States among women with unilateral breast cancer. These trends have primarily focused on younger breast cancer patients. Given the growing aging population in the United States, we sought to determine whether CPM use is also increasing in elderly patients.

Methods

This population-based study identified patients in the surveillance epidemiology and end results (SEER) data. We determined the rate of CPM as a proportion of all surgically treated patients and as a proportion of all mastectomies. We compared the unadjusted CPM rates over the study period using the Cochrane-Armitage test for trend. We used a logistic regression model to test for the factors associated with CPM utilization.

Results

We identified 261,281 patients ≥ 65 years who underwent surgical treatment for breast cancer. For all patients treated with surgery for invasive breast cancer, the use of CPM increased from 1 in 2004 to 3% in 2014 (200% increase). Among mastectomy patients, the use of CPM increased from 3 in 2004 to 7% in 2014 (133% increase). Young age, non-Hispanic white race, lobular histology, higher grade, increased stage, negative lymph node status, and recent year of diagnosis were significantly associated with increased CPM rates.

Conclusions

For elderly patients the use of CPM has continued to increase in the United States. These observations warrant concern in light of increasing evidence that CPM does not improve oncological outcomes and is associated with increased morbidity in older patients.

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Funding

Ariella Altman is in part funded by the Institute for Basic and Applied Research in Surgery and the VFW fund of the University of Minnesota.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 195, Minneapolis, MN, 55455, USA

    Schelomo Marmor, Ariella M. Altman, William T. Mayleben, Jane Y. C. Hui, Jason W. Denbo, Eric H. Jensen & Todd M. Tuttle

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  1. Schelomo Marmor
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  2. Ariella M. Altman
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  3. William T. Mayleben
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  4. Jane Y. C. Hui
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  7. Todd M. Tuttle
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Correspondence to Todd M. Tuttle.

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Marmor, S., Altman, A.M., Mayleben, W.T. et al. The use of contralateral prophylactic mastectomy among elderly patients in the United States. Breast Cancer Res Treat 177, 175–183 (2019). https://doi.org/10.1007/s10549-019-05288-8

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  • DOI: https://doi.org/10.1007/s10549-019-05288-8

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