Rising Rates of Contralateral Prophylactic Mastectomy as a Treatment for Early-Stage Breast Cancer

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Abstract

Background

The rate of contralateral prophylactic mastectomy (CPM) in women with unilateral mastectomy is increasing with no plateau.

Objectives

The aim of this study was to improve the understanding of patient- and tumor-related factors that influenced the choice of mastectomy with CPM as treatment for early-stage breast cancer at an academic medical center in New Jersey.

Methods

This was a retrospective analysis of 10 years of breast cancer data including 1556 women aged 40 to 80 years treated for breast cancer at an academic medical center. Logistic regression models identified possible associations between type of surgery and various patient- and tumor-related characteristics.

Results

Women most likely to be treated with CPM were younger (P < .0001), white (P = .003), and privately insured (P < .0001). Factors that increased the odds of receiving CPM included year of surgery (odds ratio, 1.441; confidence interval, 1.328–1.564) and residing in a relatively wealthy community (odds ratio, 11.159; confidence interval, 3.467–35.917).

Conclusions

The rate of CPM as a treatment for unilateral breast cancer continues to rise, and this treatment decision seems to be relatively independent of tumor-related factors and clinical evidence of efficacy. More research is needed to ascertain why women are choosing this surgical option.

Implications for Practice

The large majority who are choosing CPM are doing so regardless of the lack of clinical efficacy, yet there are few articles in the nursing literature preparing nurses to understand and counsel these women who may be asking for advice. Nurses are well situated to provide unbiased and fact-based information to help women making potentially life-altering decisions in response to a cancer diagnosis.

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