If you've been diagnosed with breast cancer, you have a higher risk of developing a new breast cancer than a woman who has never had the disease. Contralateral prophylactic mastectomy -- removing the opposite, healthy breast -- is an option that can reduce the risk of a new cancer developing.
The study reviewed here found that contralateral prophylactic mastectomy:
This study was reported at the 2008 American Society of Clinical Oncology (ASCO) Breast Cancer Symposium.
The researchers reviewed the medical records of nearly 83,000 women from the U.S. Surveillance, Epidemiology, and End Results (SEER) database, which is maintained by the federal government. All of the women in the study were diagnosed with stage I, II, or III breast cancer between 1998 and 2003. About 6,500 of the women (almost 8%) chose to have contralateral prophylactic mastectomy. Their medical histories were compared to those of the 76,281 women who didn't have contralateral prophylactic mastectomy.
For most women in the study, the risk of dying from breast cancer wasn't affected by having prophylactic mastectomy. Still, the risk of developing a new breast cancer was significantly reduced. For some women, lowering the risk of having to deal with a breast cancer diagnosis and treatment in the future makes contralateral prophylactic mastectomy a good choice. For younger women diagnosed with hormone-receptor-negative breast cancer, these results suggest that prophylactic mastectomy makes sense.
If you're considering contralateral prophylactic mastectomy as part of your treatment plan, you might want to talk to your doctor about:
There are also diet and lifestyle choices that you can make that will lower the risk of the diagnosed breast cancer coming back AND reduce the risk of developing a new, second breast cancer in the future. Visit the Breastcancer.org Lowering Risk for People with a Personal History page to learn more.
WASHINGTON, Sept. 8 (MedPage Today) -- Contralateral prophylactic mastectomy improves survival only for younger women with early-stage, hormone receptor-negative disease, analysis of a large government database suggests.
Records of more than 80,000 breast cancer patients revealed a statistically significant (P<0.001) 31% reduction in the mortality hazard ratio for women who had contralateral prophylactic mastectomy, Isabelle Bedrosian, M.D., of the University of Texas M.D. Anderson Cancer Center in Houston, reported here at the 2008 Breast Cancer Symposium.
A risk-stratified analysis that accounted for known influences on survival showed the same benefit in patients ages 18 to 49 with stage I-II, receptor-negative cancer (HR 0.69, P=0.030).
In contrast, older patients, those with more advanced disease, and those with receptor-positive cancer did not derive a significant survival benefit from contralateral prophylactic mastectomy.
"The improvement in cancer-specific survival appears to be related to a reduction in contralateral breast cancer events," said Dr. Bedrosian.
Contralateral prophylactic mastectomy has resulted in a 90% reduction in the relative risk of breast cancer across all studies. However, the studies produced no clear evidence of a survival benefit, said Dr. Bedrosian. Additionally, use of the procedure has evolved in the absence of established clinical guidelines.
Investigators hypothesized that contralateral prophylactic mastectomy improves breast cancer-specific survival and that the benefit is related to specific patient and tumor factors.
To test the hypothesis they turned to the Surveillance, Epidemiology, and End Results database, extracting information on breast cancers diagnosed from January 1998 through December 2003.
All patients had unilateral cancer treated with mastectomy. Patients who had contralateral prophylactic mastectomy served as cases, and the remaining patients served as controls.
After exclusions, the study population comprised 82,759 women with stage I-III breast cancer, 6,478 (7.83%) of whom had contralateral prophylactic mastectomy.
In an unadjusted comparison, contralateral prophylactic mastectomy significantly improved survival, resulting in a hazard ratio of 0.69 compared with patients who did not have the procedure (P<0.001).
Other statistically significant influences on survival were cancer stage and grade, lymph node status, estrogen-receptor status, histology (lobular versus nonlobular), and age (P<0.001).
Stratification of patients by age, disease stage, and receptor status showed no survival benefit in ER-positive patients, regardless of age (18 to 49 versus older) or disease stage (I-II versus III).
Among ER-negative patients, no survival benefit was seen in patients with stage III disease or older patients, regardless of stage.
In contrast, younger patients with stage I or II receptor-negative cancer had a hazard ratio of 0.69 for survival (P=0.03).
Contralateral prophylactic mastectomy had no effect on risk-stratified noncancer mortality, regardless of age, disease stage, or receptor status.
Further analysis showed that the cancer-specific survival benefit in younger patients with ER-negative cancer was almost entirely due to a reduction in the rate of contralateral breast cancers.
Although the rate was low regardless of whether a patient underwent prophylactic mastectomy, the rate in women who had prophylactic mastectomy was significantly lower (0.18% versus 1.11%, P=0.035).
Additionally, among women who did not have prophylactic mastectomy the rate of contralateral breast cancer was significantly higher in patients with ER-negative versus ER-positive cancer (1.11% versus 0.60%, P=0.004).
One or more study investigators reported consultant or advisory positions with AstraZeneca, Eli Lilly, and Novartis, honoraria from AstraZeneca, Genentech, and Novartis, and research funding from Eli Lilly and Organon.
Primary source: 2008 Breast Cancer Symposium Source reference: Bedrosian I et al. "Contralateral prophylactic mastectomy and survival" Breast Cancer Symposium 2008; Proceedings. Abstract 2.
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