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Contralateral Prophylactic Mastectomy Use After Neoadjuvant Chemotherapy.

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Contralateral prophylactic mastectomy (CPM) was common after neoadjuvant chemotherapy (NAC) for breast cancer, especially in younger patients with early-stage disease. This suggests a missed opportunity for breast-conserving surgery (BCS).

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Breast Cancer Research

Background:

  • Neoadjuvant chemotherapy (NAC) for breast cancer improves breast-conserving surgery (BCS) rates.
  • However, many patients still opt for mastectomy, including contralateral prophylactic mastectomy (CPM).
  • This study investigates factors influencing CPM decisions post-NAC.

Purpose of the Study:

  • To identify factors associated with contralateral prophylactic mastectomy (CPM) use in women undergoing mastectomy after neoadjuvant chemotherapy (NAC).
  • To evaluate the utilization of BCS in eligible patients post-NAC.

Main Methods:

  • Retrospective review of a institutional NAC database (2013-2017).
  • Inclusion criteria: clinical stage I-III unilateral invasive breast cancer treated with mastectomy post-NAC.
  • Comparison of clinical, pathological, and imaging characteristics, including contraindications to BCS.

Main Results:

  • 48% of 569 women underwent CPM post-NAC.
  • Younger age, lower pre-NAC stage, and absence of BCS contraindications were significantly associated with CPM.
  • Among BCS candidates, 71% still opted for CPM, with BRCA+ and family history cited as reasons.

Conclusions:

  • CPM is frequently utilized post-NAC, particularly in younger patients with earlier-stage disease.
  • While medically appropriate in some cases, the high rate of CPM among BCS candidates indicates a potential missed opportunity for breast-conserving surgery.
  • Further research may explore patient counseling and decision-making processes regarding surgical options post-NAC.