In a nutshell
This analysis examined whether contralateral prophylactic mastectomy is associated with improved survival and occurrence of contralateral breast cancer. The analysis concluded that CPM is associated with decreased occurrence of CBC but not improved survival among patients with increased genetic risk.
Some background
Women who are diagnosed with breast cancer have a higher risk of developing contralateral breast cancer (CBC). CBC is the development of a second new breast cancer in the other breast. Women who have either a BRCA mutation or a family history of breast cancer have an especially increased risk of developing CBC. This can be called an increased familial genetic risk (FGR). A BRCA mutation is a specific genetic mutation that increases the risk of female breast and ovarian cancers.
Women who have breast cancer in one breast and know they are at an increased risk of developing CBC, may decide to have a contralateral prophylactic mastectomy (CPM). Prophylactic mastectomy is the removal of the breast to prevent cancer from occurring.The number of women choosing to undergo CPM is increasing, but it is still unclear whether CPM is associated with improved outcomes, such as survival.
Methods & findings
The current analysis investigated CPM outcomes in women with a breast cancer affecting one breast. 14 studies were included in the analysis, including more than 10,000 patients who underwent CPM. The outcomes of women who had received CPM and those who had not received CPM (non-recipients) were analyzed.
Compared with non-recipients, CPM recipients had a 9% higher rate of overall survival. Rates of breast-cancer specific mortality (death directly from the breast cancer) were 31% lower in CPM recipients. There was no reduction in the risk of CBC. Among patients with an increased FGR there was a 96% decrease in the risk of CBC among those who had received CPM. However, there was no change in overall survival or breast-cancer specific mortality rates.
The bottom line
The analysis concluded that CPM is associated with decreased occurrence of CBC but not improved survival among patients with elevated FGR.
The fine print
Several of the studies used information from medical centers dedicated to the treatment of cancer. However, in reality most patients throughout the world receive their surgery in general hospitals.
What’s next?
If you have breast cancer and a family history of breast cancer or a BRCA mutation, discuss the benefits of CPM with your doctor.
Published By :
Annals of Surgery
Date :
Jun 19, 2014
