Annals of Surgical Oncology

, Volume 17, Issue 10, pp 2554–2562 | Cite as

Trends in Contralateral Prophylactic Mastectomy for Unilateral Cancer: A Report From the National Cancer Data Base, 1998–2007

  • Katharine Yao
  • Andrew K. Stewart
  • David J. Winchester
  • David P. Winchester
Healthcare Policy and Outcomes



Several studies have reported an increased rate of contralateral prophylactic mastectomy (CPM) in patients with unilateral breast cancer. This study reports on CPM trends from the American College of Surgeon’s National Cancer Data Base (NCDB) diagnosed over a 10-year period.


Data about women diagnosed with unilateral breast cancer between 1998 and 2007 undergoing CPM were extracted from the NCDB. Temporal trends were analyzed across patient demographic, tumor, and provider characteristics. Logistic regression models identified characteristics independently associated with use of CPM.


A total of 1,166,456 patients, of whom 23,218 patients underwent CPM, were reviewed; use increased from 0.4% in 1998 to 4.7% in 2007 of surgically treated patients. The greatest comparative increases in CPM was among white patients <40 years of age residing in high socioeconomic status areas with private or managed care insurance plans and treated at high-volume medical centers in the Midwest region of the country. A greater proportion of patients with in-situ disease undergo CPM compared to invasive disease. Independent factors associated with CPM include patient demographic and socioeconomic factors, tumor stage and histopathology, and provider characteristics.


Although an increase in the proportion of surgically treated women undergoing CPM was universally observed across a broad range of patient, biological, and provider factors, the increase was more noticeably associated with patient-related factors rather than tumor or biological characteristics. Further studies are needed to determine why patients seem to choose CPM and whether a survival benefit can be associated with this choice of surgical management.


Primary Breast Cancer Contralateral Prophylactic Mastectomy National Cancer Data Base Infiltrate Duct Carcinoma Unilateral Breast Cancer 


  1. 1.
    Tuttle TM, Jarosek S, Habermann EB, Arrington A, Abraham A, Morris TJ, Virnig BA. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol. 2009;27:1362–67.CrossRefPubMedGoogle Scholar
  2. 2.
    Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig B. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;25:5203–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Katipamula R, Degnim AC, Hoskin T, Boughey JC, Loprinzi C, Grant CS, Brandt KR, et al. Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol. 2009;27:4082–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Jones NB, Wilson J, Kotur L, Stephens J, Farrar WB, Agnese DM. Contralateral prophylactic mastectomy for unilateral breast cancer: an increasing trend at a single institution. Ann Surg Oncol. 2009;16:2691–6.CrossRefPubMedGoogle Scholar
  5. 5.
    McLaughlin CC, Lillquist PP, Edge SB. Surveillance of prophylactic mastectomy. Cancer. 2009;115:5404–12.CrossRefPubMedGoogle Scholar
  6. 6.
    Bilimoria KY, Stewart AK, Winchester DP, Ko CY. The National Cancer Data Base: a powerful initiative to improve cancer care in America. Ann Surg Oncol. 2008;15:683–90.CrossRefPubMedGoogle Scholar
  7. 7.
    Bilimoria KY, Bentrem DJ, Winchester DP, Stewart AK, Ko CY. 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. 2009;27:4177–81.CrossRefPubMedGoogle Scholar
  8. 8.
    US Census Bureau. Census regions and divisions of the United States, 2009.Google Scholar
  9. 9.
    Fleming ID, Phillips JL, Menck HR, Murphy GP, Winchester DP. The National Cancer Data Base report on recent hospital cancer program progress toward complete American Joint Committee on Cancer/TNM Staging. Cancer. 1997;80:2305–10.CrossRefPubMedGoogle Scholar
  10. 10.
    Greene FL, et al. editors. AJCC cancer staging manual. 6th ed. New York: Springer; 2002.Google Scholar
  11. 11.
    Percy C, Fritz A, Jack A, et al. editors. ICD-O: International classification of diseases for oncology. 3rd ed. Geneva: World Health Organization; 2000.Google Scholar
  12. 12.
    Dayo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;44:613–19.CrossRefGoogle Scholar
  13. 13.
    Arrington AK, Jarosek SL, Virnig BA, Habermann EB, Tuttle TM. Patient and surgeon characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer. Ann Surg Oncol. 2009;16:2697–704.CrossRefPubMedGoogle Scholar
  14. 14.
    Wapnir IL, Anderson S, Mamounas EP, Geyer CE, Jeong JH, Tan-Chiu E, Fisher B, Wolmark N. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node positive breast cancer trials. J Clin Oncol 2006;24:2028–37.CrossRefPubMedGoogle Scholar
  15. 15.
    Wright MJ, Park J, Fey JV, Park A, O’Neill A, Tan LK, Borgen PI, et al. Perpendicular inked versus tangential shaved margins in breast conserving surgery: does the method matter? J Am Coll Surg. 2007;204:541–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Morrow M, Jagsi R, Alderman AK, Griggs JJ, Hawley ST, Hamilton AS, Graff JJ, Katz SJ. Surgeon recommendations and receipt of mastectomy for treatment of breast cancer. JAMA. 2009;302:1551–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Chaudary MA, Millis RR, Hoskins EO, Halder M, Bulbrook RD, Cuzick J, Hayward JL. Bilateral primary breast cancer: a prospective study of disease incidence. Br J Surg. 1984;71:711–4.CrossRefPubMedGoogle Scholar
  18. 18.
    Kurian AW, McClure LA, John EM, Horn-Ross PL, Ford JM, Clarke CA. Second primary breast cancer occurrence according to hormone receptor status. J Natl Cancer Inst. 2009;101:1058–65.CrossRefPubMedGoogle Scholar
  19. 19.
    Hislop TG, Elwood JM, Coldman AJ, Spinelli JJ, Worth AJ, Ellison LG. Second primary cancers of the breast: incidence and risk factors. Br J Cancer. 1984;49:79–85.PubMedGoogle Scholar
  20. 20.
    Vaittinen P, Hemminki K. Risk factors and age incidence relationships for contralateral breast cancer. Int J Cancer. 2000;88:998–1002.CrossRefPubMedGoogle Scholar
  21. 21.
    Graeser MK, Engel C, Rhiem K, Gadzicki D, Bick U, Kast K, Froster EG, et al. Contralateral breast cancer risk in BRCA1 and BRCA2 mutation carriers. J Clin Oncol. 2009;27:5887–92.CrossRefPubMedGoogle Scholar
  22. 22.
    Frank T, Deffenbaugh AM, Reid JE, Hulick M, Ward BE, Lingenfelter B, Gumpper KL, Tavtigian SV, Pruss DR, Critchfield GC. Clinical characteristics of individuals with germline mutations in BRCA1 and BRCA2: analysis of 10,000 individuals. J Clin Oncol. 2002;20:1480–90.CrossRefPubMedGoogle Scholar
  23. 23.
    Herrinton LJ, Barlow WE, Yu O, Geiger AM, Elmore JG, Barton MB, Harris EL, et al. Efficacy of prophylactic mastectomy in women with unilateral breast cancer: a Cancer Research Network project. J Clin Oncol. 2005;23:4275–86.CrossRefPubMedGoogle Scholar
  24. 24.
    Peralta EA, Ellenhorn JD, Wagman LD, Dagis A, Andersen JS, Chu DZJ. Contralateral prophylactic mastectomy improves the outcome of selected patients undergoing mastectomy for breast cancer. Am J Surg 2000;180:439–45.CrossRefPubMedGoogle Scholar
  25. 25.
    Metcalfe K, Lynch HT, Ghadirian P, Tung N, Olivotto I, Warner E, Olopade OI et al. Contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. J Clin Oncol. 2004;22:2328–35.CrossRefPubMedGoogle Scholar
  26. 26.
    Brekelmans CT, Seynaeve C, Menke-Pluymers M, Bruggenwirth HT, Tilanus-Linthorst MM, Bartels CC, Kriege M et al. Survival and prognostic factors in BRCA-1 associated breast cancer. Ann Oncol. 2006;17:391–400.CrossRefPubMedGoogle Scholar
  27. 27.
    Rosen PP, Groshen S, Kinne DW, Hellman S. Contralateral breast carcinoma: an assessment of risk and prognosis in stage I (T1N0M0) and stage II (T1N1M0) patients with 20-year follow-up. Surgery. 1989;106:904–10.PubMedGoogle Scholar
  28. 28.
    Healey EA, Cook FE, Orav EJ, Schnitt SJ, Connolly JL, Harris JR. Contralateral breast cancer: clinical characteristics and impact on prognosis. J Clin Oncol. 1993;11:1545–52.PubMedGoogle Scholar
  29. 29.
    Robbins GF, Berg JW. Bilateral primary breast cancers: a prospective clinicopathological study. Cancer. 1964;17:1501–27.CrossRefPubMedGoogle Scholar
  30. 30.
    Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, et al. 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. 2002;347:1233–41.CrossRefPubMedGoogle Scholar
  31. 31.
    Bernstein JL, Lapinski RH, Thakore SS, Doucette JT, Thompson WD. The descriptive epidemiology of second primary breast cancer. Epidemiology 2003;14:552–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Bertelsen L, Bernstein L, Olsen JH, Mellemkjaer L, Haile RW, Lynch CF, Malone KE, et al. Effect of systemic adjuvant treatment on risk for contralateral breast cancer in the Women’s Environment, Cancer and Radiation Epidemiology Study. J Natl Cancer Inst. 2008;100:32–40.CrossRefPubMedGoogle Scholar
  33. 33.
    Sorbero ME, Dick AW, Beckjord EB, Ahrendt G. Diagnostic breast magnetic resonance imaging and contralateral prophylactic mastectomy. Ann Surg Oncol. 2009;16:1597–605.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Katharine Yao
    • 1
  • Andrew K. Stewart
    • 2
  • David J. Winchester
    • 1
  • David P. Winchester
    • 1
  1. 1.Department of SurgeryUniversity of Chicago, Pritzker School of Medicine, NorthShore University Health System, Evanston HospitalEvanstonUSA
  2. 2.National Cancer Data Base, Commission on CancerAmerican College of SurgeonsChicagoUSA

Personalised recommendations