Improved Long-term Survival with Contralateral Prophylactic Mastectomy among Young Women


Background: Despite mixed survival data, the utilization of contralateral prophylactic mastectomy (CPM)for the prevention of a contralateral breast cancer (CBC) has increased significantly over the last 15 years,especially among women less than 40. We set out to look at our own experience with CPM, focusing on outcomesin women less than 40, the sub-population with the highest cumulative lifetime risk of developing CBC. With anextended follow-up, we hoped to demonstrate differences in the long-term disease free survival (DFS) and overallsurvival (OS) among groups who underwent the procedure (CPM) versus those that did not (NCPM). Materialsand
Methods: We performed a retrospective review of all breast cancer patients less than age 40 diagnosed atMount Sinai Medical Center between January 1, 1980 and December 31, 2010 (n=481). Among these patients, 42were identified as having undergone CPM, while 195 were confirmed as being CPM-free during the observationperiod. A univariate and multivariate analyses were performed.
Results: The CPM group had a significantlyhigher percentage of patients who were diagnosed between 2000 and 2010 (95.2% vs 40%, p=0.0001). The CPMgroup had significantly smaller tumors (0-2cm.: 41.7% vs 24.8%, p=0.04). Among the entire group of patients, theoverall five- and 10-year DFS were 81.3% and 73.3%, respectively. CPM was significantly associated [HR 2.35(1.02, 5.41); p=0.046] with 10-year OS, although a similar effect was not observed for five-year OS.
Conclusions:We found that CPM has increased dramatically over the last 15 years, especially among white women with locallyadvanced disease. In patients less than 40, who are thought to be at greatest cumulative risk of secondary breastcancer, CPM provided an OS advantage, regardless of genetics, tumor or patient characteristics, and which wasonly seen after 10 years of follow-up.