Originally published as JCO Early Release 10.1200/JCO.2005.10.080 on March 28 2005

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Efficacy of Prophylactic Mastectomy in Women With Unilateral Breast Cancer: A Cancer Research Network Project

From the Cancer Research Network, Kaiser Permanente Northern California, Oakland; Kaiser Permanente Southern California, Pasadena, CA; Group Health Cooperative; University of Washington Department of Biostatistics and School of Medicine, Seattle, WA; Harvard Pilgrim Health Care and Harvard Medical School, Boston, MA; Kaiser Permanente Northwest Center for Health Research, Portland, OR; and HealthPartners, Minneapolis, MN

Address reprint requests to Lisa J. Herrinton, PhD, Division of Research, Northern California Kaiser Permanente, 2000 Broadway Ave, Oakland, CA 94612; e-mail: lisa.herrinton{at}kp.org

PURPOSE: We investigated the efficacy of contralateral prophylactic mastectomy (CPM) in reducing contralateral breast cancer incidence and breast cancer mortality among women who have already been diagnosed with breast cancer.

METHODS: This retrospective cohort study comprised approximately 50,000 women who were diagnosed with unilateral breast cancer during 1979 to 1999. Using computerized data confirmed by chart review, we identified 1,072 women (1.9%) who had CPM. We obtained covariate information for these women and for a sample of 317 women who did not undergo CPM.

RESULTS: The median time from initial breast cancer diagnosis to the end of follow-up was 5.7 years. Contralateral breast cancer developed in 0.5% of women with CPM, metastatic disease developed in 10.5%, and subsequent breast cancer developed in 12.4%; 8.1% died from breast cancer. Contralateral breast cancer developed in 2.7% of women without CPM, and 11.7% died of breast cancer. After adjustment for initial breast cancer characteristics, treatment, and breast cancer risk factors, the hazard ratio (HR) for the occurrence of contralateral breast cancer after CPM was 0.03 (95% CI, 0.006 to 0.13). After adjustment for breast cancer characteristics and treatment, the HRs for the relationship of CPM with death from breast cancer, with death from other causes, and with all-cause mortality were 0.57 (95% CI, 0.45 to 0.72), 0.78 (95% CI, 0.57 to 1.06), and 0.60 (95% CI, 0.50 to 0.72), respectively.

CONCLUSION: CPM seems to protect against the development of contralateral breast cancer, and although women who underwent CPM had relatively low all-cause mortality, CPM also was associated with decreased breast cancer mortality.

Supported by grant No. U19 CA NCI 79689 from the National Cancer Institute, Bethesda, MD.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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