Decreasing contralateral prophylactic mastectomy rates in average-risk women with unilateral breast cancer

Hannah Kapur; Rebecca Warburton; Jin-Si Pao; Carol Dingee; Leo Chen; Elaine McKevitt

doi:10.1016/j.amjsurg.2021.03.040

Decreasing contralateral prophylactic mastectomy rates in average-risk women with unilateral breast cancer

Am J Surg. 2021 Jun;221(6):1172-1176. doi: 10.1016/j.amjsurg.2021.03.040. Epub 2021 Mar 24.

Authors

Hannah Kapur¹, Rebecca Warburton², Jin-Si Pao³, Carol Dingee⁴, Leo Chen⁵, Elaine McKevitt⁶

Affiliations

¹ Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. Electronic address: hannah.kapur@alumni.ubc.ca.
² Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. Electronic address: RWarburton@providencehealth.bc.ca.
³ Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. Electronic address: JPao@providencehealth.bc.ca.
⁴ Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. Electronic address: ckdingee@telus.net.
⁵ Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. Electronic address: leochen1@mail.ubc.ca.
⁶ Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. Electronic address: EMckevitt@providencehealth.bc.ca.

PMID: 33795126
DOI: 10.1016/j.amjsurg.2021.03.040

Abstract

Background: Contralateral prophylactic mastectomy (CPM) is not recommended for average-risk women with breast cancer due to lack of evidence for survival benefit, yet recent studies demonstrate increasing CPM rates.

Methods: We identified patients with breast cancer treated with unilateral mastectomy (UM) with or without CPM. Rates of malignancy in CPM specimens and factors in CPM rates were assessed.

Results: From 2013 to 2017, 1353 patients had UM and 355 had CPM. Our institution's occult malignancy detection rate was 5.04%. CPM rates decreased from 31.6% to 17.3% (p < 0.001) over 5 years. Compared to patients receiving UM only, patients receiving CPMs had significantly higher reconstruction rates (p < 0.001), which did not significantly change over time (p = 0.551) and tended to be younger (p < 0.001).

Conclusions: Patients having UM have low risk of contralateral malignancy. CPM is associated with younger age and breast reconstruction, suggesting factors to identify for patient and provider education.

Keywords: Breast cancer; Contralateral prophylactic mastectomy; Mastectomy rates; Quality indicators.

MeSH terms

Adult
Age Factors
Aged
Aged, 80 and over
Breast Neoplasms / surgery*
Canada
Female
Humans
Mammaplasty / statistics & numerical data
Mastectomy / statistics & numerical data
Middle Aged
Prophylactic Mastectomy / statistics & numerical data*
Risk Factors