Is the Rising Use of Bilateral Mastectomy for Unilateral Breast Cancer Advantageous?

September 8, 2014

Is the Rising Use of Bilateral Mastectomy for Unilateral Breast Cancer Advantageous?

  1. Henry Mark Kuerer, MD, PhD, FACS

Compared with breast-conserving therapy or unilateral mastectomy, bilateral mastectomy had no overall survival benefit.

  1. Henry Mark Kuerer, MD, PhD, FACS

Bilateral mastectomy's use has been propelled by patient preference despite the dearth of evidence for survival benefits. In an analysis of California Cancer Registry data from 1998 through 2011 including 189,734 women with unilateral stage 0 to 3 breast cancer, researchers evaluated outcomes of bilateral mastectomy, breast-conserving therapy (BCT) including radiotherapy, and unilateral mastectomy (median follow-up, 89 months).

Rates of bilateral mastectomy rose from 2.0% in 1998 to 12.3% in 2011. The rate of increase was most dramatic among breast cancer patients aged ≤40, escalating from 3.6% to 33.0%. BCT was the treatment in 55.0% of cases, bilateral mastectomy in 6.0%, and unilateral mastectomy in 39.0%. Use of reconstruction was not documented. Bilateral mastectomy was more common in non-Latina white women, those with private insurance, and those who received care at National Cancer Institute designated cancer centers. Ten-year survival following BCT, bilateral mastectomy, and unilateral mastectomy was 83.2%, 81.2%, and 79.9%, respectively. Unilateral mastectomy had a statistically significant survival disadvantage compared with BCT, with an absolute difference of <4%.

Comment

Reasons for pursuing contralateral prophylactic mastectomy include the perception of elevated risk that may be substantiated by a strong family history of breast and/or ovarian carcinoma, known mutation carrier status, and better availability and quality of breast reconstruction (the last representing a potential confounding factor not included in this analysis). What's clear is that, for most patients, removal of an otherwise healthy breast does not seem to significantly affect breast cancer survival 10 years later compared with unilateral mastectomy or breast-conserving surgery.

Editor Disclosures at Time of Publication

  • Disclosures for Henry Mark Kuerer, MD, PhD, FACS at time of publication Speaker's bureau Physicians’ Education Resource, LLC Grant / Research support Susan G. Komen Breast Cancer Foundation Editorial boards Annals of Surgical Oncology Leadership positions in professional societies Alliance for Clinical Trials in Oncology (Chair, Education Committee); Society of Surgical Oncology (Chair, Curriculum Ad Hoc Committee, Breast Program Directors

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Reader Comments (1)

DAVID SMITH Physician, Surgery, Specialized, Dallas

For most women I treat who chose B mastectomy, They understanding that they are not likely to improve their overall survival. There are many personal/psychological reasons for their very informed choice. The question that needs to be asked is what is patient satisfaction with the choice in addition to overall survival at 5 and 10 years.

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