Contralateral prophylactic mastectomy: current perspectives

Figures & data

Table 1 Studies examining trends in CPM in the US

Study	Year published	Study period	Percentage increase in CPM of all patients over the study period	Percentage increase in CPM of all mastectomy patients over the study period	Data source
Tuttle et al^Citation14 (invasive cancer)	2007	1998–2003	2.7	6.8	SEER
Tuttle et al^Citation15 (DCIS)	2009	1998–2005	3.1	12.0	SEER
Jones et al^Citation17	2009	1998–2007	NA	9.6	Ohio state-NCCN network
Yao et al^Citation16	2010	1998–2007	4.3	NA	NCDB
King et al^Citation11	2011	1997–2005	NA	17.5	MSKCC single institution
Pesce et al^Citation20	2014	2003–2010	5.6	NA	NCDB
Kurian et al^Citation19	2014	1998–2011	10.3	NA	California Cancer Registry
Kummerow et al^Citation18	2015	1998–2011	9.3	24.3

Abbreviations: CPM, contralateral prophylactic mastectomy; SEER, Surveillance Epidemiology End Results; DCIS, ductal carcinoma in situ; NA, not available; NCDB, National Cancer Data Base; NCCN, National Comprehensive Cancer Network; MSKCC, Memorial Sloan Kettering Cancer Center.

Table 2 Single- and multi-institution studies examining disease-free and overall survival in patients undergoing CPM

Study	Year published	No of CPM patients	Data source	DFS/DSS (adjusted)	OS (adjusted)	Follow-up
Peralta et al^Citation32	2000	64	Retrospective, single institution	DFS: 71% CPM vs 53% control (P=0.06)	64% CPM vs 48% control (P=0.26)	Mean: 6.8 years
Herrinton et al^Citation33	2005	1,072	Cancer Research Network, Kaiser Permanente	DSS: HR =0.57 (95% CI, 0.45–0.72)	All-cause mortality: HR =0.60 (95% CI, 0.50–0.72)	Median: 5.7 years
Bedrosian et al^Citation34	2010	8,900	SEER	DSS: HR =0.63 (95% CI, 0.57–0.69)	NA	Median: 47 months
Brewster et al^Citation35	2012	532	Retrospective, single institution	DFS: HR =0.75 (95% CI, 0.59–0.97)	OS: HR =0.74 (95% CI, 0.56–0.99)	Median: 4.5 years
Boughey et al^Citation39	2010	385	Retrospective, single institution	DFS: HR =0.67 (95% CI, 0.54–0.84)	OS: HR =0.77 (95% CI, 0.60–0.98)	Median: 17.3 years
Chung et al^Citation36	2012	177	Retrospective, single institution	No difference in DFS between UM and bilateral mastectomy (P=0.081)	No difference in OS between UM and bilateral mastectomy (P=0.42)	Median: 61 months
Yao et al^Citation37	2013	14,994	NCDB	NA	OS: HR =0.88 (95% CI, 0.83–0.93)	Median: 5 years
Kruper et al^Citation38	2014	26,526	SEER	DSS: HR =0.83 (95% CI, 0.77–0.90)	OS: HR =0.77 (95% CI, 0.73–0.82)	NA
Kurian et al^Citation19	2014	11,692	California Cancer Registry	NA	OS: HR =1.02 (95% CI, 0.94–1.11)	Median: 89.1 months

Abbreviations: CPM, contralateral prophylactic mastectomy; DFS, disease-free survival; DSS, disease-specific survival; OS, overall survival; UM, unilateral mastectomy; HR, hazard ratio; CI, confidence interval; SEER, Surveillance Epidemiology End Results; NA, not available; NCDB, National Cancer Data Base.

Table 3 Studies examining CBC rates

Study	Publication year	Data source	Follow-up	CBC risk
Soerjomataram et al^Citation60	2005	Eindhoven Cancer Registry	4.9 years	SIR 3.5 (CI, 3.2–3.8)
Gao et al^Citation61	2003	SEER	5 years 10 years 15 years 20 years	3.0% 6.1% 9.1% 12%
Herrinton et al^Citation33	2005	Cancer Research Network, Kaiser Permanente	5.7 years	2.7%
Cuzick et al^Citation62	2010	ATAC trial	5 years 10 years	1%–1.8% 3.2% Armidex arm 4.9% Tamoxifen arm
Nichols et al^Citation63	2011	SEER	10 years	0.26 per 100/year (50-year-old ER positive) 0.45 per 100/year (50-year-old ER negative)
Perez et al^Citation64	2011	Herceptin trials NCCTG N9831 and NSABP B31	4 years	0.5%–1.0% control arm 0.7%–0.9% Herceptin arm
Wapnir et al^Citation65	2011	NSABP B17/B24	15 years	10% lumpectomy 10.2%–10.8% lumpectomy/XRT 7.3% lumpectomy + Tamoxifen
Reiner et al^Citation66	2013	WECARE Non-BRCA carriers with family history	10 years	4.6%–15.6% depending on family history
Pilewskie et al^Citation67	2014	Single institution MKSCC	8 years	3.5% MRI 5.1% no MRI
McCormick et al^Citation68	2015	RTOG 9804 DCIS patients	7 years	4.8% Tamoxifen + observation 3.9% Tamoxifen + radiation

Abbreviations: CBC, contralateral breast cancer; SIR, standardized incidence ratio; CI, confidence interval; SEER, Surveillance Epidemiology End Results; ATAC, Arimidex, Tamoxifen, Alone or in Combination Trial; ER, estrogen receptor; NCCTG, North Central Cancer Treatment Group; NSABP, National Surgical Adjuvant Bowel and Breast Project; XRT, radiotherapy; WECARE, Women’s Environmental Cancer and Radiation Epidemiology Study; MRI, magnetic resonance imaging; MSKCC, Memorial Sloan Kettering Cancer Center; RTOG, Radiation Therapy Oncology Group; DCIS, ductal carcinoma in situ.

Table 4 Pros and cons of CPM

Pros of undergoing CPM	Cons of undergoing CPM
Decrease risk of contralateral breast cancer	No improvement in survival
Improved symmetry with reconstruction	Decreased sensation along the chest wall
Avoid future screening mammograms and possible biopsies	Longer recovery time
Possibly avoid breast radiationdepending on tumor characteristics	Increase in operative complications
	Loss of breasts
	Possible negative effects on sexuality

Abbreviation: CPM, contralateral prophylactic mastectomy.

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