Clinical Management Factors Contribute to the Decision for Contralateral Prophylactic Mastectomy

Abstract

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.

Contralateral Prophylactic Mastectomy: Current Perspectives

“…16 A 2011 study from Memorial Sloan Kettering reported that 6.7% mastectomy patients underwent CPM in 1997, which increased to 24.2% in 2005. 11 These studies and others show increasing CPM across all stages, different areas of the country, all ages, insurance types, and facility types. 11,[14][15][16][17]21 Certain characteristics were similar across all studies.…”

“…11 These studies and others show increasing CPM across all stages, different areas of the country, all ages, insurance types, and facility types. 11,[14][15][16][17]21 Certain characteristics were similar across all studies. CPM rates are highest among Caucasians, and patients with higher socioeconomic status, with private insurance, and treated at high-volume centers.…”

“…These two studies were the first in a string of studies examining the increasing CPM rate across the US (Table 1). 11,[14][15][16][17][18][19][20] In 2010, a report from the National Cancer Data Base (NCDB) showed an increase in CPM from 0.4% in 1998 to 4.7% in 2007. 16 A 2011 study from Memorial Sloan Kettering reported that 6.7% mastectomy patients underwent CPM in 1997, which increased to 24.2% in 2005.…”

“…71 Indeed, a singleinstitution study reported that immediate breast reconstruction was performed in 87% of patients undergoing CPM compared to 51% of patients undergoing UM. 11 Friends, family, and spouses also influence patients, 10,71 particularly if one of these individuals has been through breast cancer or other cancers.…”

Radiation Therapy Following Breast Conserving Surgery for Ductal Carcinoma in situ: Yes or No?

“…(30) Re-excisions have the potential for added discomfort, surgical complications, compromise in cosmetic outcomes, additional stress for patients and families and increased health care costs and have also been associated with conversion to bilateral mastectomy. (31) The Society of Surgical Oncology (SSO), American Society for Radiation Oncology (ASTRO) and the American Society of Clinical Oncology (ASCO) developed a Consensus Guideline on margins for BCS with wholebreast radiotherapy (WBRT) in DCIS. (32) The guideline was based on the results of a meta-analysis including 20 studies, 7,883 DCIS patients with known margins status and 865 ipsilateral breast tumor recurrences (IBTR).…”