Contralateral Prophylactic Mastectomy : Characteristics Influencing Utilization

Purpose: Breast conservation has been shown to have similar mortality rates as compared to mastectomy. We hypothesized that variables involving the patient, tumor and surgeon influence the treatment a patient may choose. Methods: Retrospective review of a prospectively maintained database of all patients who underwent surgical treatment for breast cancer between 2000 and 2009 was performed. Multivariate logistic regression models were used to compare characteristics associated with breast conservation therapy (BCT) and contralateral prophylactic mastectomy (CPM). Results: Of 1826 patients, 806 underwent BCT and 207 underwent CPM. Exclusion criteria included unilateral mastectomy (n=761), bilateral disease, stage IV disease, and incomplete records. Larger average tumor size and number of lymph nodes examined were associated with CPM (both p<0.0001). There were higher odds of patients who underwent CPM when younger than 40 (OR=3.1), less than 50 years of age (OR=2.5), with a history of breast cancer (OR=4.7), lobular histology (OR=2.3), invasive histology (OR=2.1), and multi-centric (OR=8.2). Patients treated by surgeons with greater than 10 years of experience were less than half as likely to undergo CPM (OR=0.4), however when treated by a surgeon not subspecialty trained in surgical oncology the patient was more likely to undergo CPM (OR=3.4). Conclusions: Our study is one of the first to evaluate patient comorbidities, personal history of breast cancer, and length of surgeon experience and the influence each may have on usage of CPM. Our data also suggest that there may be a training gap to bridge for general surgeons, because more surgery is becoming subspecialized.