Contralateral prophylactic mastectomy

Simões, Ricardo Santos; Bernardo, Wanderley Marques; Silvinato, Antônio; Frank, Thais Amanda; Buzzini, Renata

doi:10.1590/1806-9282.64.01.3

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…It is demonstrated that CPM signi cantly reduced the risk of CBC and the incidence of distant metastases (DM) in patients with UBC, but there is insu cient evidence suggesting that CPM can improve survival in females at average risk [14][15][16]. Fayanju et al [17] retrieved studies on CPM published before March 2012 for meta-analysis and concluded that CPM signi cantly reduced the risk of breast cancer speci c mortality, with improved patient overall survival (OS).…”

Section: Introductionmentioning

confidence: 99%

Prognosis and Decision-making Analysis of Contralateral Prophylactic Mastectomy among female patients with stage 0–III unilateral breast cancer in Chinese population: a retrospective cohort study

zhu,

min,

zhang

et al. 2023

Preprint

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Purpose It was demonstrated that contralateral prophylactic mastectomy (CPM) provides no survival benefit for patients with average risk breast cancer, but the application in patients with early-stage breast cancer has increased. This study aims to explore the application trend, survival benefits, decision-making factors, and satisfaction of CPM based on the patients undergoing CPM in a Chinese institution. Methods The 0-III stage unilateral breast cancer (UBC) patients who received breast surgery in the First Medical Center of the PLA General Hospital from 2005 to 2017 were selected. The surgical procedures include simple mastectomy (SM), nipple-sparing mastectomy (NSM) and breast conserving surgery (BCS). Those patients who underwent preventive breast surgery on the healthy side were defined as the CPM group. The Cochran Armitage trend test was used to compare the longitudinal application trend of the annual surgical number and proportion of the four surgical procedures. Cox proportional regression analysis and Kaplan-Meier curve were performed to compare the overall survival (OS) and disease free survival (DFS) rates between CPM group and unilateral mastectomy (UM) group. Proportional propensity score matching (PSM) with a 1:1 ratio was used to match the two groups and secondary survival analysis was performed. Logistic regression models were used to test predictive factors related to patients' CPM surgical decision-making. A self-made satisfaction rating scale were used to analyze the satisfaction of CPM procedure and the impact on quality of life. Results 4,276 patients were included in the study, with 73 (1.7%) patients receiving CPM, 3567 (83.4%) receiving SM, 151 (35.3%) receiving NSM, and 485 (11.3%) receiving BCS. CPM surgery was first used in 2007, with a peak application rate of 3.02% in 2016 and a decrease to 1.05% in 2017. 3,791 patients with CPM and UM were included in the survival analysis, with a median follow-up time of 66.60 months. Compared to UM patients, neither the KM survival curve nor Cox regression hazard analysis of CPM showed better OS (p = 0.963; p = 0.834). After PSM, CPM also did not exhibit significant survival benefits in OS (HR 0.876, 95% CI 0.253–3.034, p = 0.335) and DFS (HR 0.922, 95% CI 0.629–1.352, p = 0.409). The logistic regression analysis showed that NSM surgery and early TNM stage were independent factors to promote the CPM decision-making of patients. 73 patients in the CPM group showed high overall satisfaction (84.9%) and relatively low physical satisfaction (69.9%). And a significant percentage of patients expressed that the physical labor was affected. Conclusion Our study suggested CPM does not provide any OS and DFS survival benefits compared to UM. Although most patients with CPM were generally satisfied, many gave a low evaluation of cosmetic results. Therefore, clinicians should fully communicate with patients before surgery and be more cautious in giving CPM recommendations.

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Section: Introductionmentioning

confidence: 99%

Prognosis and Decision-making Analysis of Contralateral Prophylactic Mastectomy among female patients with stage 0–III unilateral breast cancer in Chinese population: a retrospective cohort study

zhu,

min,

zhang

et al. 2023

Preprint

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“…Originally considered a means to reduce the risks associated with a breast cancer diagnosis, a notable body of literature outlines the limited benefit of a CPM in the majority of breast cancer patients. [1][2][3][4] Though there may be some evidence of a reduction in the incidence of contralateral breast cancer, the ability of CPM to improve breast cancer-related mortality has not been definitively demonstrated. 1 In a consensus statement by the American Society of Breast Surgery (ASBrS), the specific scenarios for which a CPM should be considered are outlined.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] Though there may be some evidence of a reduction in the incidence of contralateral breast cancer, the ability of CPM to improve breast cancer-related mortality has not been definitively demonstrated. 1 In a consensus statement by the American Society of Breast Surgery (ASBrS), the specific scenarios for which a CPM should be considered are outlined. 3 These recommendations mirror those for high-risk patients recommended for bilateral prophylactic mastectomies in the absence of a breast cancer diagnosis, such as certain genetic mutation carriers or those with a history of prior mantle wall radiation.…”

Section: Introductionmentioning

confidence: 99%

Contralateral prophylactic mastectomy in the setting of breast cancer diagnosis and their insurance coverage in the United States

Ngaage

Klein

et al. 2021

Breast J

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Background: Contralateral prophylactic mastectomy (CPM) is more common in the United States than the rest of the world. However, the benefit of this procedure is still under question in many breast cancer scenarios. CPM utilization in the United States is in part dependent on a patient's health insurance coverage of breast oncology surgery and any desired reconstruction. However, there are great discrepancies in the coverage provided by insurers. Methods:The authors conducted a cross-sectional analysis of insurance policies for a CPM in the setting of diagnosed breast cancer. One hundred companies were selected based on their state enrollment and market share. Their policies were identified through a Web-based search and telephone interviews, and their medical necessity criteria were extracted.Results: Of the 100 companies assessed, 36 (36%) had a policy for CPM. Within those, significantly more provided coverage than denied the procedure (72% vs. 25%, p < 0.0001), with the remainder providing case-by-case coverage. Eleven criteria were identified from preauthorized policies, the most common prerequisite was breast cancer diagnosis under 45 years old (n = 9, 35%). Most policies did not differentiate between gender in their policies (n = 25, 69%), but of those that did, 100% (n = 11) provided coverage for men and women, with 82% (n = 9) requiring further criteria from the female patients. Conclusion:The coverage of CPM in the United States varies from complete denial to unrestricted approval. This may be due to conflicting reports in the literature as to the utility of the procedure. The decision to undergo this procedure must be taken with thoughtful consideration and the support of a multidisciplinary approach.

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Decision-making experiences of breast cancer patients related to contralateral prophylactic mastectomy—a systematic meta-synthesis of qualitative studies

Zhao

Hong

et al. 2023

Support Care Cancer

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Contralateral prophylactic mastectomy

Cited by 3 publications

References 13 publications

Prognosis and Decision-making Analysis of Contralateral Prophylactic Mastectomy among female patients with stage 0–III unilateral breast cancer in Chinese population: a retrospective cohort study

Prognosis and Decision-making Analysis of Contralateral Prophylactic Mastectomy among female patients with stage 0–III unilateral breast cancer in Chinese population: a retrospective cohort study

Contralateral prophylactic mastectomy in the setting of breast cancer diagnosis and their insurance coverage in the United States

Decision-making experiences of breast cancer patients related to contralateral prophylactic mastectomy—a systematic meta-synthesis of qualitative studies

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