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General Discussions

Contralateral Prophylactic Mastectomies

By Lisa Schulmeister, RN, MN, APRN-BC, OCN®, FAAN
The number of contralateral prophylactic mastectomies (CPM) among US women with a diagnosis of unilateral invasive breast cancer has increased over the past decade, and this increase is particularly evident among younger women. Rates of CPM among women vary, depending on the population studied, although national statistics show that the percentage of women with unilateral invasive breast cancer undergoing a CPM increased from 2.2% in 1998 to 11% in 2011. This increase has occurred despite the lack of evidence for a survival benefit from bilateral surgery, in addition to possible complications and their associated costs. Factors that are thought to contribute to the increase in the rate of CPM include increased testing for BRCA1/2 mutations, magnetic resonance imaging, and reconstruction surgery for symmetry, among others.

Researchers from the American Cancer Society and the Dana-Farber Cancer Institute used a nationwide population-based cancer database, the North American Association of Central Cancer Registries, to examine the temporal trends in, and the factors associated with, CPM among men who received a diagnosis of unilateral invasive breast cancer. They examined the records of 6332 men with breast cancer undergoing surgery, and found that for the first time, the number of men having both the affected breast and the unaffected breast tissue removed in a double mastectomy has increased significantly. The percentage of double mastectomies in men nearly doubled to 5.6% in 2010-2011 from 3% in 2004-2005.

Jemal A, Lin CC, DeSantis C, et al. Temporal trends in and factors associated with contralateral prophylactic mastectomy among US men with breast cancer [published online before print September 2, 2015]. JAMA Surg. doi:10.1001/jamasurg.2015.2657. 
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