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. 2015 Apr 1;8(4):3748-64.
eCollection 2015.

Predictors for contralateral prophylactic mastectomy in breast cancer patients

Yun Fu  1 , Zhigang Zhuang  2 , Michelle Dewing  3 , Sophia Apple  4 , Helena Chang  3
Affiliations

Predictors for contralateral prophylactic mastectomy in breast cancer patients

Yun Fu et al. Int J Clin Exp Pathol. .

Abstract

Background: In recent years, radical breast cancer surgery has been largely replaced by breast conservation treatment, due to early diagnosis and more effective adjuvant treatment. While breast conservation is mostly preferred, the trend of bilateral mastectomy has risen in the United States. The aim of this study is to determine factors influencing patients' choice for having contralateral prophylactic mastectomy (CPM).

Methods: This is a retrospective study of 373 patients diagnosed with primary invasive breast cancer who were treated by bilateral or unilateral mastectomy (BM or UM) at the Revlon/UCLA Breast Center between Jan. 2002 and Dec. 2010. In the BM group, only those with unilateral breast cancer who chose CPM were included in the analysis.

Results: When compared with the UM group, the following factors were found to be associated with BM: younger age, pre-menopausal, a family history of breast/ovarian cancer, BRCA mutation, more breast biopsies, history of breast augmentation, having MRI study within 6 months before the surgery, more likely to have reconstruction and sentinel lymph node biopsy (SLNB) and fewer had neoadjuvant/adjuvant chemotherapy/radiation. When patients with bilateral breast cancer were excluded, multivariate logistic regression analysis indicated younger patients with negative nodes, SLNB as the only nodal surgery and positive family history were significant factors predicting CPM and immediate reconstruction using tissue expanders or implants.

Conclusion: Younger age, lower TN stage, requiring only SLNB and high risk family history predict contralateral prophylactic mastectomy. Tissue expander/implant-based reconstructions were more frequently chosen by patients with BM.

Keywords: BRCA mutation; Breast cancer; bilateral mastectomy; contralateral prophylactic mastectomy; predictors.

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Figures

Figure 1
Figure 1
Flow chart of study enrollment.
Figure 2
Figure 2
Surgeons’ influence on types of mastectomy and reconstruction. A. Comparison of breast surgeons in our center on laterality of mastectomy (P=0.532). B. Comparison of plastic surgeons on laterality of mastectomy (P=0.438). C. Comparison of types of reconstruction in our center (P=0.037).
Appendix Figure 1
Appendix Figure 1
C-statistics of the logistic model (0.911, 95% CI 0.879~0.943, P<0.001).
Appendix Figure 2
Appendix Figure 2
Pie graph of the reasons for patients without reconstruction according to the medical notes.
See this image and copyright information in PMC

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