Contralateral prophylactic mastectomy use after neoadjuvant chemotherapy Journal Article

Authors: Christian, N.; Zabor, E. C.; Cassidy, M.; Flynn, J.; Morrow, M.; Gemignani, M. L.
Article Title: Contralateral prophylactic mastectomy use after neoadjuvant chemotherapy
Abstract: Background: Neoadjuvant chemotherapy (NAC) for breast cancer increases breast-conserving surgery (BCS) rates, but many women opt for mastectomy with contralateral prophylactic mastectomy (CPM). Here we evaluate factors associated with CPM use in women undergoing mastectomy post-NAC. Methods: A retrospective institutional NAC database review identified women with clinical stage I-III, unilateral invasive breast cancer undergoing unilateral mastectomy (UM) or CPM mastectomy from 9/2013 to 12/2017. Clinical/pathologic characteristics, imaging, and presence of contraindications to BCS post-NAC were compared, with subset analysis of BCS candidates. The multivariable analysis was adjusted for potential confounders. Results: Five hundred sixty-nine women underwent mastectomy after NAC, 297 (52%) UM and 272 (48%) CPM. On univariable analysis, younger age, BRCA+, lower pre-NAC clinical stage, pathologic complete response, and axillary surgery extent were associated with CPM (all p < 0.01). Favorable post-NAC clinical factors of no residual palpable disease, clinically negative nodes, complete response on breast imaging, and no post-NAC contraindication to BCS were also associated with CPM (all p < 0.01). On multivariable analysis, young age (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.91–0.95), lower pre-NAC stage (OR 0.51, 95% CI 0.34–0.77), and no contraindication to BCS (OR 3.12, 95% CI 2.02–4.82) were significantly associated with CPM. Among the 203 (35%) women who had no contraindications to BCS post-NAC, 145 (71%) underwent CPM. BRCA+ and family history were reasons more frequently cited for mastectomy among CPM than UM (p < 0.001). Conclusions: CPM was performed in 48% of women undergoing mastectomy after NAC; younger women with earlier-stage cancers were more likely to undergo CPM. While increased use of CPM in women with more favorable disease is medically appropriate, our findings indicate a lost opportunity for use of BCS. © 2019, Society of Surgical Oncology.
Keywords: adult; major clinical study; cancer staging; antineoplastic agent; breast cancer; retrospective study; neoadjuvant chemotherapy; genetic screening; prophylactic mastectomy; estrogen receptor positive breast cancer; human epidermal growth factor receptor 2 positive breast cancer; human; female; article; progesterone receptor positive breast cancer
Journal Title: Annals of Surgical Oncology
Volume: 27
Issue: 3
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2020-03-01
Start Page: 743
End Page: 749
Language: English
DOI: 10.1245/s10434-019-08038-8
PUBMED: 31732944
PROVIDER: scopus
PMCID: PMC7004848
Notes: Article -- Export Date: 2 March 2020 -- Source: Scopus
Citation Impact
MSK Authors
  1. Monica Morrow
    508 Morrow
  2. Mary L Gemignani
    161 Gemignani
  3. Emily Craig Zabor
    159 Zabor
  4. Jessica Flynn
    33 Flynn