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. 2012 Nov 15;118(22):5637-43.
doi: 10.1002/cncr.27574. Epub 2012 Apr 19.

Association between contralateral prophylactic mastectomy and breast cancer outcomes by hormone receptor status

Abenaa M Brewster  1 , Isabelle Bedrosian, Patricia A Parker, Wenli Dong, Susan K Peterson, Scott B Cantor, Melissa Crosby, Yu Shen
Affiliations

Association between contralateral prophylactic mastectomy and breast cancer outcomes by hormone receptor status

Abenaa M Brewster et al. Cancer. .

Abstract

Background: The effect of contralateral prophylactic mastectomy (CPM) on the survival of patients with early-stage breast cancer remains controversial. The objective of this study was to evaluate the benefits of CPM using a propensity scoring approach that reduces selection bias from the nonrandom assignment of patients in observational studies.

Methods: A total of 3889 female patients with stage I to III breast cancer were identified who were treated at The University of Texas MD Anderson Cancer Center from 1997 to 2009. We assessed the association between CPM and disease-free (DFS) and overall survival (OS), by using Cox proportional hazards models to estimate hazard ratios (HRs), and by matching patients in the CPM and no-CPM groups using propensity scores (n = 497 pairs).

Results: With a median follow-up time of 4.5 years, CPM was associated with improved DFS (HR, 0.75; 95% confidence interval [CI], 0.59-0.97) and OS (HR, 0.74; 95% CI, 0.56-0.99), adjusted for prognostic factors. The improved DFS was seen predominantly among hormone receptor-negative (HR, 0.60; 95% CI, 0.38-0.95) compared with hormone receptor-positive patients (HR, 0.80; 95% CI, 0.58-1.10). For the matched patient cohort, stratified survival analysis also showed an improvement in DFS with CPM (HR, 0.48; 95% CI, 0.22-1.01) in hormone receptor-negative patients that was nearly statistically significant.

Conclusions: CPM was associated with improved DFS for some patients with hormone receptor-negative breast cancer, after reducing selection bias. Identifying subsets of patients most likely to benefit from CPM may have important implications for a more personalized approach to treatment decisions about CPM.

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Figures

Figure 1
Figure 1
Disease-Free Survival (DFS) for Patients Who Underwent Contralateral Prophylactic Mastectomy (CPM) Compared with Those Who Did Not Undergo CPM among Hormone Receptor-Negative Patients by Stage and HER2/neu Status. Abbreviations: ER, estrogen-receptor; PR, progesterone receptor; HR, hazard ratio; E, number of events; N, number of patients at risk.
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