- In the last 10 years there has been a significant focus on the role of contralateral prophylactic mastectomy and the risk of contralateral breast cancer
- Single-institution studies and Surveillance, Epidemiology, and End Results program (SEER) data:
- Have found contralateral prophylactic mastectomy rates to be as high as 25%:
- Which continue to increase
- Further, this trend seems to be limited to the United States
- Which continue to increase
- Have found contralateral prophylactic mastectomy rates to be as high as 25%:
- Nichols et al:
- Reviewed rates of contralateral breast cancer between 1976 and 2006 using the SEER database
- Overall, they found the rate of contralateral breast cancer to be declining:
- Approximately 3% per year since 1985
- From 1990 forward, they found this benefit to be restricted to those presenting with an ER+ breast cancer:
- With annual incidence rates of contralateral breast cancer of 0.25% to 0.37%:
- When the index cancer was diagnosed after age 30 years
- With annual incidence rates of contralateral breast cancer of 0.25% to 0.37%:
- The rates of contralateral breast cancer were higher in patients with ER– negative breast cancers:
- But still remained reasonably low with annual incidence rates of contralateral breast cancer of 0.45% to 0.65% when the index cancer was diagnosed after age 40 years
- The use of adjuvant endocrine therapy:
- Has contributed to this decline as it reduces the risk of contralateral breast cancer by approximately 50%
- Contralateral prophylactic mastectomy:
- Is attributed with approximately a 90% to 94% overall reduction in the risk of contralateral breast cancer:
- Not 100%
- Is attributed with approximately a 90% to 94% overall reduction in the risk of contralateral breast cancer:
- Contralateral prophylactic mastectomy:
- Does not improve overall survival:
- Recent modeling suggests the added absolute benefit of contralateral prophylactic mastectomy to overall survival:
- Is less than 1.45%
- Recent modeling suggests the added absolute benefit of contralateral prophylactic mastectomy to overall survival:
- Does not improve overall survival:
- The American Society of Breast Surgeons published a consensus statement with indications and suggestions for patient management and decision making with regard to contralateral prophylactic mastectomy:
- Discouraging the procedure for women with unilateral breast cancer at average risk for contralateral cancer
- References
- Nichols HB, Berrington de Gonzalez A, Lacey JV, Rosenberg PS, Anderson WF. Declining incidence of contralateral breast cancer in the United States from 1975 to 2006. J Clin Oncol. 2011;29(12):1564-1569.
- Early Breast Cancer Trialists’ Collaborative Group, Davies C, Godwin J, et al. Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet. 2011;378(9793):771-784.
- King TA, Sakr R, Patil S, et al. Clinical management factors contribute to the decision for contralateral prophylactic mastectomy. J Clin Oncol. 2011;29(16):2158-2164.
- Metcalfe K, Lynch HT, Ghadirian P, et al. Contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. J Clin Oncol. 2004;22(12):2328-2335.
- Portschy PR, Kuntz KM, Tuttle TM. Survival outcomes after contralateral prophylactic mastectomy: a decision analysis. J Natl Cancer Inst. 2014;106(8).
- Boughey JC, Attai DJ, Chen SL, et. al.. Contralateral prophylactic mastectomy consensus statement from the American Society of Breast Surgeons: additional considerations and a framework for shared decision making. Ann Surg Oncol. 2016 Oct;23(10):3106-3111.
Rodrigo Arrangoiz MS, MD, FACS, FSSO 