Increase in contralateral prophylactic mastectomy: Echoes of a bygone era?: Surgical trends for unilateral breast cancer

Chee Chee H Stucky, Richard J. Gray, Nabil Wasif, Amylou Dueck, Barbara A Pockaj

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Abstract

Objectives: Surgical therapy for invasive breast cancer includes breast conservation therapy (BCT), unilateral mastectomy (UM), or bilateral mastectomy, including contralateral prophylactic mastectomy (CPM) with or without reconstruction (±R). The goal of this study was to determine factors associated with CPM. Methods: A breast cancer database collected from 2000 through 2008 was retrospectively reviewed. Treatment groups analyzed included BCT, UM ± R, and CPM ± R. Variables were compared using ANOVA F-tests and chi-square tests. Multivariate analysis was performed using logistic regression. Results: A total of 1,391 patients underwent surgery for invasive breast cancer: 69% BCT, 21% UM, and 10% bilateral mastectomy. Of those undergoing bilateral mastectomy, 30% had bilateral cancer and were excluded from analysis. The rate of CPM increased significantly from 0 to 20% (p < 0.001), whereas the rate of UM remained relatively stable. Factors associated with CPM included younger age, significant family history, genetic testing, positive BRCA gene mutation, and preoperative magnetic resonance imaging (MRI). Tumor characteristics associated with CPM included positive axillary lymph node metastases and triple-negative disease (ER-/PR-/HER2 normal). Breast reconstruction was more common among women who underwent CPM (p < 0.001). On multivariate regression comparing BCT with CPM, younger age, larger tumors, multifocal disease, and MRI significantly predicted CPM. Comparing UM with CPM, only age and genetic testing significantly predicted CPM. Conclusions: The rate of bilateral mastectomy for unilateral breast cancer is increasing. This is particularly true for younger patients with strong family history. The availability of breast reconstruction may play a role and the effects of stage and multifocal disease needs further exploration.

Original languageEnglish (US)
JournalAnnals of Surgical Oncology
Volume17
Issue numberSUPPL. 3
DOIs
StatePublished - Oct 2010

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Mastectomy
Segmental Mastectomy
Breast Neoplasms
Mammaplasty
Genetic Testing
Prophylactic Mastectomy
Unilateral Breast Neoplasms
Magnetic Resonance Imaging
Neoplasms
Chi-Square Distribution
Analysis of Variance
Multivariate Analysis
Logistic Models
Lymph Nodes
Databases
Neoplasm Metastasis
Mutation
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

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title = "Increase in contralateral prophylactic mastectomy: Echoes of a bygone era?: Surgical trends for unilateral breast cancer",
abstract = "Objectives: Surgical therapy for invasive breast cancer includes breast conservation therapy (BCT), unilateral mastectomy (UM), or bilateral mastectomy, including contralateral prophylactic mastectomy (CPM) with or without reconstruction (±R). The goal of this study was to determine factors associated with CPM. Methods: A breast cancer database collected from 2000 through 2008 was retrospectively reviewed. Treatment groups analyzed included BCT, UM ± R, and CPM ± R. Variables were compared using ANOVA F-tests and chi-square tests. Multivariate analysis was performed using logistic regression. Results: A total of 1,391 patients underwent surgery for invasive breast cancer: 69{\%} BCT, 21{\%} UM, and 10{\%} bilateral mastectomy. Of those undergoing bilateral mastectomy, 30{\%} had bilateral cancer and were excluded from analysis. The rate of CPM increased significantly from 0 to 20{\%} (p < 0.001), whereas the rate of UM remained relatively stable. Factors associated with CPM included younger age, significant family history, genetic testing, positive BRCA gene mutation, and preoperative magnetic resonance imaging (MRI). Tumor characteristics associated with CPM included positive axillary lymph node metastases and triple-negative disease (ER-/PR-/HER2 normal). Breast reconstruction was more common among women who underwent CPM (p < 0.001). On multivariate regression comparing BCT with CPM, younger age, larger tumors, multifocal disease, and MRI significantly predicted CPM. Comparing UM with CPM, only age and genetic testing significantly predicted CPM. Conclusions: The rate of bilateral mastectomy for unilateral breast cancer is increasing. This is particularly true for younger patients with strong family history. The availability of breast reconstruction may play a role and the effects of stage and multifocal disease needs further exploration.",
author = "Stucky, {Chee Chee H} and Gray, {Richard J.} and Nabil Wasif and Amylou Dueck and Pockaj, {Barbara A}",
year = "2010",
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doi = "10.1245/s10434-010-1259-x",
language = "English (US)",
volume = "17",
journal = "Annals of Surgical Oncology",
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TY - JOUR

T1 - Increase in contralateral prophylactic mastectomy

T2 - Echoes of a bygone era?: Surgical trends for unilateral breast cancer

AU - Stucky, Chee Chee H

AU - Gray, Richard J.

AU - Wasif, Nabil

AU - Dueck, Amylou

AU - Pockaj, Barbara A

PY - 2010/10

Y1 - 2010/10

N2 - Objectives: Surgical therapy for invasive breast cancer includes breast conservation therapy (BCT), unilateral mastectomy (UM), or bilateral mastectomy, including contralateral prophylactic mastectomy (CPM) with or without reconstruction (±R). The goal of this study was to determine factors associated with CPM. Methods: A breast cancer database collected from 2000 through 2008 was retrospectively reviewed. Treatment groups analyzed included BCT, UM ± R, and CPM ± R. Variables were compared using ANOVA F-tests and chi-square tests. Multivariate analysis was performed using logistic regression. Results: A total of 1,391 patients underwent surgery for invasive breast cancer: 69% BCT, 21% UM, and 10% bilateral mastectomy. Of those undergoing bilateral mastectomy, 30% had bilateral cancer and were excluded from analysis. The rate of CPM increased significantly from 0 to 20% (p < 0.001), whereas the rate of UM remained relatively stable. Factors associated with CPM included younger age, significant family history, genetic testing, positive BRCA gene mutation, and preoperative magnetic resonance imaging (MRI). Tumor characteristics associated with CPM included positive axillary lymph node metastases and triple-negative disease (ER-/PR-/HER2 normal). Breast reconstruction was more common among women who underwent CPM (p < 0.001). On multivariate regression comparing BCT with CPM, younger age, larger tumors, multifocal disease, and MRI significantly predicted CPM. Comparing UM with CPM, only age and genetic testing significantly predicted CPM. Conclusions: The rate of bilateral mastectomy for unilateral breast cancer is increasing. This is particularly true for younger patients with strong family history. The availability of breast reconstruction may play a role and the effects of stage and multifocal disease needs further exploration.

AB - Objectives: Surgical therapy for invasive breast cancer includes breast conservation therapy (BCT), unilateral mastectomy (UM), or bilateral mastectomy, including contralateral prophylactic mastectomy (CPM) with or without reconstruction (±R). The goal of this study was to determine factors associated with CPM. Methods: A breast cancer database collected from 2000 through 2008 was retrospectively reviewed. Treatment groups analyzed included BCT, UM ± R, and CPM ± R. Variables were compared using ANOVA F-tests and chi-square tests. Multivariate analysis was performed using logistic regression. Results: A total of 1,391 patients underwent surgery for invasive breast cancer: 69% BCT, 21% UM, and 10% bilateral mastectomy. Of those undergoing bilateral mastectomy, 30% had bilateral cancer and were excluded from analysis. The rate of CPM increased significantly from 0 to 20% (p < 0.001), whereas the rate of UM remained relatively stable. Factors associated with CPM included younger age, significant family history, genetic testing, positive BRCA gene mutation, and preoperative magnetic resonance imaging (MRI). Tumor characteristics associated with CPM included positive axillary lymph node metastases and triple-negative disease (ER-/PR-/HER2 normal). Breast reconstruction was more common among women who underwent CPM (p < 0.001). On multivariate regression comparing BCT with CPM, younger age, larger tumors, multifocal disease, and MRI significantly predicted CPM. Comparing UM with CPM, only age and genetic testing significantly predicted CPM. Conclusions: The rate of bilateral mastectomy for unilateral breast cancer is increasing. This is particularly true for younger patients with strong family history. The availability of breast reconstruction may play a role and the effects of stage and multifocal disease needs further exploration.

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