Trend and survival benefit of contralateral prophylactic mastectomy among men with stage I–III unilateral breast cancer in the USA, 1998–2016

2021 ◽  
Author(s):  
Yinlong Yang ◽  
Liangwei Pan ◽  
Zhiming Shao
Keyword(s):  
Breast Cancer ◽  
Survival Benefit ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Stage I ◽  
Unilateral Breast Cancer ◽  
The Usa

The impact of breast reconstruction on the decision to undergo contralateral prophylactic mastectomy.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 96-96
Author(s):  
L. J. McGhan ◽  
B. A. Pockaj ◽  
R. J. Gray ◽  
S. P. Bagaria ◽  
S. A. McLaughlin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Breast Reconstruction ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Tumor Grade ◽  
Breast Cancer Patients ◽  
Unilateral Breast Cancer ◽  
The Impact ◽  
Implant Reconstruction

96 Background: In the last decade there has been an increase in the incidence of contralateral prophylactic mastectomy (CPM) for unilateral breast cancer. Although many factors have been proposed to explain this trend, the impact of breast reconstruction on the decision to undergo CPM has not been extensively studied. Methods: A retrospective review of breast cancer patients from Surveillance, Epidemiology and End Results (SEER) registry data (2004-2008) was conducted. Characteristics of patients undergoing CPM were evaluated. Results: 71,176 patients with a diagnosis of stage I-III infiltrating ductal or lobular breast cancer underwent mastectomy for their primary lesion. Among these, 10,558 patients (15%) underwent a CPM. A significantly higher proportion of women undergoing CPM had reconstruction performed (44%) than those patients not undergoing CPM (13%), p<0.001. On multivariate analysis (Table), significant variables predicting CPM included age <50 years (OR 10.12), breast reconstruction (OR 3.58), and lobular histology (OR 1.41), all p<0.001. Of the 12,466 patients (18%) who underwent reconstruction, 4,636 (37%) had implant reconstruction, 4,498 (36%) had tissue reconstruction, and 1,122 (9%) had combined tissue/implant reconstruction (no data for 18%). On multivariate analysis, predictors of reconstruction included age <50 years (OR 20.5; CI 18.5-22.7), year of surgery (2008 vs. 2004; OR 1.60; CI 1.49-1.71), low tumor grade (OR 1.19; CI 1.13-1.25) and ER+ status (OR 1.16; 95% CI 1.10-1.23). The use of radiation therapy was associated with a lower likelihood of pursuing reconstruction (OR 0.61; CI 0.58-0.65). Conclusions: Apart from age, the factor most strongly associated with CPM is the decision to have reconstructive surgery performed. This suggests that CPM may not be purely associated with risk-reduction but also with treatment factors such as cosmesis. [Table: see text]

Is less more? The association between hospital volume and low-value breast cancer surgeries.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 68-68
Author(s):  
Christina Ahn Minami ◽  
Ginger Jin ◽  
Tari A. King ◽  
Elizabeth A. Mittendorf
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Hospital Volume ◽  
Prophylactic Mastectomy ◽  
Survival Rates ◽  
Contralateral Prophylactic Mastectomy ◽  
Lymph Node Biopsy ◽  
Choosing Wisely ◽  
Axillary Lymph ◽  
Unilateral Breast Cancer

68 Background: Hospital volume is often equated with surgical quality. In breast surgical oncology, higher hospital volume has been associated with higher overall survival rates, but whether it is a proxy for quality with respect to low-value care remains unexplored. We thus examined the association between hospital volume and the use of three breast surgeries identified as low-value by the Choosing Wisely campaign. Methods: Patients with stage 0-III unilateral breast cancer diagnosed from 2013-2016 were identified in the National Cancer Database. The outcomes of interest were: 1) contralateral prophylactic mastectomy (CPM), 2) axillary lymph node dissection (ALND) for breast conserving therapy (BCT) patients with cT1-2N0 disease and <2 positive nodes, and 3) sentinel lymph node biopsy (SLNB) in women >70 years old with cT1N0 hormone receptor-positive (HR+) cancer. Multivariable regression models with restricted cubic splines were used to examine the association between annual hospital volume and outcomes of interest, after adjusting for patient-, disease-, and hospital-level risk factors. Results: Overall, 13.6% of 841,610 women with unilateral Stage I-III breast cancer underwent CPM, 9.2% of 832,205 BCT patients with clinical T1-T2N0 disease underwent ALND, and 85.7% of women >70 years of age with cT1N0 HR+ cancer underwent SLNB over the study period. In adjusted analyses that defined hospital volume by decile, patients treated in the first and tenth decile hospitals had lower odds of undergoing CPM as compared to those treated in the middle deciles (Table). BCT patients with cT1-2N0 disease treated in hospitals in the first and second decile had higher odds of undergoing an ALND than patients treated at higher volume hospitals. Hospital volume did not have an overall significant association with SLNB use in women >70 years old with cT1N0 HR+ disease. Conclusions: The relationship between hospital volume and performance of low-value breast surgeries differed for each Choosing Wisely recommendation, indicating that hospital volume is not a reliable proxy for quality with respect to low-value practices. Additional studies to identify practice-specific deimplementation strategies are needed. [Table: see text]

scholarly journals Cost-Effectiveness of Contralateral Prophylactic Mastectomy Versus Routine Surveillance in Patients With Unilateral Breast Cancer

2011 ◽  
Vol 29 (22) ◽  
pp. 2993-3000 ◽  
Author(s):  
Benjamin Zendejas ◽  
James P. Moriarty ◽  
Jamie O'Byrne ◽  
Amy C. Degnim ◽  
David R. Farley ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Cost Effective ◽  
Model Parameters ◽  
Average Risk ◽  
Unilateral Breast Cancer ◽  
Routine Surveillance ◽  
Life Years

Purpose Contralateral prophylactic mastectomy (CPM) rates in women with unilateral breast cancer are increasing despite controversy regarding survival advantage. Current scrutiny of the medical costs led us to evaluate the cost-effectiveness of CPM versus routine surveillance as an alternative contralateral breast cancer (CBC) risk management strategy. Methods Using a Markov model, we simulated patients with breast cancer from mastectomy to death. Model parameters were gathered from published literature or national databases. Base-case analysis focused on patients with average-risk breast cancer, 45 years of age at treatment. Outcomes were valued in quality-adjusted life-years (QALYs). Patients' age, risk level of breast cancer, and quality of life (QOL) were varied to assess their impact on results. Results Mean costs of treatment for women age 45 years are comparable: $36,594 for the CPM and $35,182 for surveillance. CPM provides 21.22 mean QALYs compared with 20.93 for surveillance, resulting in an incremental cost-effectiveness ratio (ICER) of $4,869/QALY gained for CPM. To prevent one CBC, six CPMs would be needed. CPM is no longer cost-effective for patients older than 70 years (ICER $62,750/QALY). For BRCA-positive patients, CPM is clearly cost-effective, providing more QALYs while being less costly. In non-BRCA patients, cost-effectiveness of CPM is highly dependent on assumptions regarding QOL for CPM versus surveillance strategy. Conclusion CPM is cost-effective compared with surveillance for patients with breast cancer who are younger than 70 years. Results are sensitive to BRCA-positive status and assumptions of QOL differences between CPM and surveillance patients. This highlights the importance of tailoring treatment for individual patients.

Contralateral Prophylactic Mastectomy for Unilateral Breast Cancer: An Increasing Trend at a Single Institution

2009 ◽  
Vol 16 (10) ◽  
pp. 2691-2696 ◽  
Author(s):  
Natalie B. Jones ◽  
John Wilson ◽  
Linda Kotur ◽  
Julie Stephens ◽  
William B. Farrar ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Single Institution ◽  
Unilateral Breast Cancer ◽  
Increasing Trend

Contralateral prophylactic mastectomy for patients with unilateral breast cancer

2007 ◽  
Vol 7 (8) ◽  
pp. 1117-1122 ◽  
Author(s):  
Todd Tuttle ◽  
Elizabeth Habermann ◽  
Anasooya Abraham ◽  
Timothy Emory ◽  
Beth Virnig
Keyword(s):  
Breast Cancer ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Unilateral Breast Cancer

Clinical Management Factors Contribute to the Decision for Contralateral Prophylactic Mastectomy

2011 ◽  
Vol 29 (16) ◽  
pp. 2158-2164 ◽  
Author(s):  
Tari A. King ◽  
Rita Sakr ◽  
Sujata Patil ◽  
Inga Gurevich ◽  
Michelle Stempel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prophylactic Mastectomy ◽  
Breast Conservation ◽  
Contralateral Prophylactic Mastectomy ◽  
Cancer Center ◽  
Unilateral Breast Cancer ◽  
Brca Mutations ◽  
Immediate Reconstruction ◽  
Magnetic Resonance Imaging Mri ◽  
Index Cancer

Purpose To determine whether increasing rates of contralateral prophylactic mastectomy (CPM) are due to recognition of risk factors for contralateral breast cancer (CBC) or treatment factors related to the index lesion. Methods From 1997 to 2005, 2,965 patients with stage 0 to III primary unilateral breast cancer underwent mastectomy at Memorial Sloan-Kettering Cancer Center. Patients who did and did not undergo CPM within 1 year of treatment for their index cancer were compared to identify independent predictors of CPM. Results The rate of CPM was 13.8% (n = 407), increasing from 6.7% in 1997 to 24.2% in 2005 (P < .0001). Patients with BRCA mutations or prior mantle radiation (n = 52) accounted for 13% of those having CPM. The rate of CPM by surgeon varied from 1% to 26%. Multivariate logistic regression adjusting for surgeon-identified white race (odds ratio [OR] = 3.3), immediate reconstruction (OR = 3.3), family history of breast cancer (OR = 2.9), magnetic resonance imaging (MRI) at diagnosis (OR = 2.8), age younger than 50 years (OR = 2.2), noninvasive histology (OR = 1.8), and prior attempt at breast conversation (OR = 1.7) to be independent predictors of CPM. Conclusion These data suggest that increasing use of CPM is not associated with increased recognition of patients at high risk for CBC. Treatment factors, such as immediate reconstruction, preoperative MRI, and unsuccessful attempts at breast conservation, are associated with increased rates of CPM. Efforts to optimize breast conservation, minimize unnecessary tests, and improve patient education about the low risk of CBC may help to curb this trend.

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