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Predictors of contralateral prophylactic mastectomy in women with unilateral breast cancer and association with survival outcomes
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Predictors of contralateral prophylactic mastectomy in women with unilateral breast cancer and association with survival outcomes
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Journal Article
Predictors of contralateral prophylactic mastectomy in women with unilateral breast cancer and association with survival outcomes
2025
Overview
Background: Surgical options for breast cancer have evolved significantly over the past decades. Lumpectomy with radiation remains the preferred approach for early-stage cancers, while unilateral mastectomy rates have declined. However, bilateral mastectomy rates have increased. We aimed to determine contemporary trends and predictors of contralateral prophylactic mastectomy (CPM) and its impact on oncological outcomes among women with breast cancer. Methods: We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) 17 database between 2000 and 2019 among women with non-metastatic breast cancer who had undergone lumpectomy, unilateral mastectomy, or CPM. We collected demographic, clinicopathologic, and treatment data to analyze trends in surgical management and identify predictors for CPM using a multinomial logistic regression model. Survival outcomes between surgical options were compared using the Kaplan-Meier curve. Results: A total of 1130455 women who had undergone lumpectomy (60.8%), unilateral mastectomy (34.0%), or bilateral mastectomy (5.2%) were included. The proportion of women undergoing lumpectomy and bilateral mastectomy increased from 4.3% to 5.8% and 2.2% to 5.6%, respectively, between 2000 and 2019, while the rate of unilateral mastectomy decreased from 5.4% to 4.8%. Contralateral prophylactic mastectomy was associated with younger age, later diagnostic year, White race, marital status (married, divorced), advanced cancer stage, and node positivity, while lumpectomy was linked to older age, higher income, urban/metropolitan living, early-stage cancer, and smaller tumour. Overall survival was higher for lumpectomy and CPM than unilateral mastectomy (p < 0.0001). However, breast cancer-specific mortality was lowest for lumpectomy (p < 0.0001). Conclusion: Contralateral prophylactic mastectomy is influenced by various demographic and clinicopathological factors but offers limited long-term survival and oncological benefits.
Publisher
CMA Impact, Inc
Subject
