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Contralateral Prophylactic Mastectomy Provides No Survival Benefit in Young Women with Estrogen Receptor-Negative Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Several studies have shown that contralateral prophylactic mastectomy (CPM) provides a disease-free and overall survival (OS) benefit in young women with estrogen receptor (ER)-negative breast cancer. We utilized the National Cancer Data Base to evaluate CPM’s survival benefit for young women with early -stage breast cancer in the years that ER status was available.

Methods

We selected 14,627 women ≤45 years of age with American Joint Committee on Cancer stage I–II breast cancer who underwent unilateral mastectomy or CPM from 2004 to 2006. Five-year OS was compared between those who had unilateral mastectomy and CPM using the Kaplan–Meier method and Cox regression analysis.

Results

A total of 10,289 (70.3 %) women underwent unilateral mastectomy and 4,338 (29.7 %) women underwent CPM. Median follow up was 6.1 years. After adjusting for patient age, race, insurance status, co-morbidities, year of diagnosis, ER status, tumor size, nodal status, grade, histology, facility type, facility location, use of adjuvant radiation and chemohormonal therapy, there was no difference in OS in women <45 years of age who underwent CPM compared towith those who underwent unilateral mastectomy (hazard ratio [HR] = 0.93; p = 0.39). In addition, Tthere was no improvement in OS in women <45 years of age with T1N0 tumors who underwent CPM versus unilateral mastectomy (HR = 0.85; p = 0.37) after adjusting for the aforementioned factors. Among women ≤45 years of age with ER-negative tumors who underwent CPM, there was no improvement in OS compared with women who underwent unilateral mastectomy (HR = 1.12; p = 0.32) after adjusting for the same aforementioned factors.

Conclusions

CPM provides no survival benefit to young patients with early-stage breast cancer, and no benefit to ER-negative patients. Future studies with longer follow-up are required in this cohort of patients.

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Acknowledgment

We would like to thank the Auxiliary of Evanston and Glenbrook Hospitals for their generous support of this project through the Breast Research Fellowship program.

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Authors and Affiliations

  1. Department of Surgery, NorthShore University Health System, Evanston, IL, USA

    Catherine Pesce, Erik Liederbach, David J. Winchester & Katharine Yao

  2. Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL, USA

    Chihsiung Wang & Brittany Lapin

Authors
  1. Catherine Pesce
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  2. Erik Liederbach
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  3. Chihsiung Wang
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  4. Brittany Lapin
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  5. David J. Winchester
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  6. Katharine Yao
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Correspondence to Catherine Pesce.

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Pesce, C., Liederbach, E., Wang, C. et al. Contralateral Prophylactic Mastectomy Provides No Survival Benefit in Young Women with Estrogen Receptor-Negative Breast Cancer. Ann Surg Oncol 21, 3231–3239 (2014). https://doi.org/10.1245/s10434-014-3956-3

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  • DOI: https://doi.org/10.1245/s10434-014-3956-3

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