Originally published as JCO Early Release 10.1200/JCO.2007.12.3141 on October 22 2007

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Increasing Use of Contralateral Prophylactic Mastectomy for Breast Cancer Patients: A Trend Toward More Aggressive Surgical Treatment

Todd M. Tuttle, Elizabeth B. Habermann, Erin H. Grund, Todd J. Morris, Beth A. Virnig

From the Department of Surgery, Division of Surgical Oncology; Division of Health Policy and Management, University of Minnesota School of Public Health; and the University of Minnesota Medical School, Minneapolis, MN

Address reprint requests to Todd M. Tuttle, MD, University of Minnesota, Department of Surgery, Division of Surgical Oncology, 420 Delaware St SE, Minneapolis, MN; e-mail: tuttl006{at}umn.edu

Purpose: Many patients with unilateral breast cancer choose contralateral prophylactic mastectomy to prevent cancer in the opposite breast. The purpose of our study was to determine the use and trends of contralateral prophylactic mastectomy in the United States.

Patients and Methods: We used the Surveillance, Epidemiology and End Results database to review the treatment of patients with unilateral breast cancer diagnosed from 1998 through 2003. We determined the rate of contralateral prophylactic mastectomy as a proportion of all surgically treated patients and as a proportion of all mastectomies.

Results: We identified 152,755 patients with stage I, II, or III breast cancer; 4,969 patients chose contralateral prophylactic mastectomy. The rate was 3.3% for all surgically treated patients; 7.7%, for patients undergoing mastectomy. The overall rate significantly increased from 1.8% in 1998 to 4.5% in 2003. Likewise, the contralateral prophylactic mastectomy rate for patients undergoing mastectomy significantly increased from 4.2% in 1998 to 11.0% in 2003. These increased rates applied to all cancer stages and continued to the end of our study period. Young patient age, non-Hispanic white race, lobular histology, and previous cancer diagnosis were associated with significantly higher rates. Large tumor size was associated with a higher overall rate, but with a lower rate for patients undergoing mastectomy.

Conclusion: The use of contralateral prophylactic mastectomy in the United States more than doubled within the recent 6-year period of our study. Prospective studies are needed to understand the decision-making processes that have led to more aggressive breast cancer surgery.

published online ahead of print at www.jco.org on October 22, 2007.

Presented in part at the Annual Meeting of the Society of Surgical Oncology, Washington, DC, March 16, 2007.

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

Related Correspondence

• Contralateral Prophylactic Mastectomy: Mind the Genetics
  Evangelos Briasoulis and Dimitrios H. Roukos
  JCO 2008 26: 1909-1910 [Full Text]

This article has been cited by other articles:

				T. Liakakos and E. G. Lykoudis Local Control, Aggressive Surgery, and Overall Survival for Breast Cancer Ann. Surg. Oncol., May 1, 2008; 15(5): 1544 - 1546. [Full Text] [PDF]

				E. Briasoulis and D. H. Roukos Contralateral Prophylactic Mastectomy: Mind the Genetics J. Clin. Oncol., April 10, 2008; 26(11): 1909 - 1910. [Full Text] [PDF]

				T. M. Tuttle, E. B. Habermann, and B. A. Virnig In Reply J. Clin. Oncol., April 10, 2008; 26(11): 1910 - 1910. [Full Text] [PDF]

				More Breast Cancer Patients Choosing Contralateral Prophylactic Mastectomy Journal Watch Women's Health, December 6, 2007; 2007(1206): 2 - 2. [Full Text]