Contralateral prophylactic mastectomy for unilateral breast cancer: an increasing trend at a single institution

An increasing trend in the use of contralateral prophylactic mastectomy (CPM) for the treatment of unilateral breast cancer has been observed nationally. The purpose of this study was to confirm this trend and to identify differences between the groups that chose unilateral mastectomy alone or with CPM.

A prospectively maintained breast cancer database was retrospectively reviewed. Age, histologic grade, stage, education, family history, tumor receptor status, and use of immediate reconstruction were evaluated. Statistical analysis was performed by Fisher's exact test, chi(2) test, and Student's t-test.

Between 1998 and 2007, a total of 1639 women who selected UM and 201 who had UM and CPM for unilateral breast cancer were identified. An increasing trend in CPM was observed (6.5% in 1999 vs. 16.1% in 2007). The CPM group was significantly younger (mean age 47.8 vs. 55.1 years, P < .001). No difference in histologic grade was noted between the two groups; however, an increasing trend toward CPM was observed with lower-stage disease. Women with a higher educational level were more likely to have CPM (P < .001). Women with a family history of cancer were also more likely to have CPM (57% vs. 41%, P < .001). Use of reconstruction was similar between the groups (6.0% for CPM vs. 6.7% for UM, P = NS).

Our experience parallels the national trend of increasing use of CPM in women diagnosed with unilateral breast cancer. Women who chose to have CPM were younger, more highly educated, and more likely to have a family history of cancer.