Annals of Surgical Oncology

, Volume 21, Issue 10, pp 3231–3239

Contralateral Prophylactic Mastectomy Provides No Survival Benefit in Young Women with Estrogen Receptor-Negative Breast Cancer

  • Catherine Pesce
  • Erik Liederbach
  • Chihsiung Wang
  • Brittany Lapin
  • David J. Winchester
  • Katharine Yao
Breast Oncology

Abstract

Background

Several studies have shown that contralateral prophylactic mastectomy (CPM) provides a disease-free and overall survival (OS) benefit in young women with estrogen receptor (ER)-negative breast cancer. We utilized the National Cancer Data Base to evaluate CPM’s survival benefit for young women with early -stage breast cancer in the years that ER status was available.

Methods

We selected 14,627 women ≤45 years of age with American Joint Committee on Cancer stage I–II breast cancer who underwent unilateral mastectomy or CPM from 2004 to 2006. Five-year OS was compared between those who had unilateral mastectomy and CPM using the Kaplan–Meier method and Cox regression analysis.

Results

A total of 10,289 (70.3 %) women underwent unilateral mastectomy and 4,338 (29.7 %) women underwent CPM. Median follow up was 6.1 years. After adjusting for patient age, race, insurance status, co-morbidities, year of diagnosis, ER status, tumor size, nodal status, grade, histology, facility type, facility location, use of adjuvant radiation and chemohormonal therapy, there was no difference in OS in women <45 years of age who underwent CPM compared towith those who underwent unilateral mastectomy (hazard ratio [HR] = 0.93; p = 0.39). In addition, Tthere was no improvement in OS in women <45 years of age with T1N0 tumors who underwent CPM versus unilateral mastectomy (HR = 0.85; p = 0.37) after adjusting for the aforementioned factors. Among women ≤45 years of age with ER-negative tumors who underwent CPM, there was no improvement in OS compared with women who underwent unilateral mastectomy (HR = 1.12; p = 0.32) after adjusting for the same aforementioned factors.

Conclusions

CPM provides no survival benefit to young patients with early-stage breast cancer, and no benefit to ER-negative patients. Future studies with longer follow-up are required in this cohort of patients.

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Catherine Pesce
    • 1
  • Erik Liederbach
    • 1
  • Chihsiung Wang
    • 2
  • Brittany Lapin
    • 2
  • David J. Winchester
    • 1
  • Katharine Yao
    • 1
  1. 1.Department of SurgeryNorthShore University Health SystemEvanstonUSA
  2. 2.Center for Biomedical Research InformaticsNorthShore University Health SystemEvanstonUSA

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