Refers to the removal of a normal intact breast among women with unilateral breast cancer.
SEER Registry shows an increasing trend.
Patients more likely to receive contralateral prophylactic mastectomy are young patients, Caucasian women, patients with higher education, and patients with a family history of breast cancer.
The presence of infiltrating lobular histology is a strong predictor of CPM, although the risk of contralateral breast cancer is not significantly increased for infiltrating lobular histology as compared with infiltrating ductal cancer.
Multicentric breast cancer is associated with higher rates of contralateral prophylactic mastectomy.
Preoperative MRI is associated with higher rates.
Associated with obesity.
CPM is an effective strategy to reduce the risk of contralateral breast cancer, reducing the incidence by more than 90%.
It has not been improved that CPM improves survival, in fact, it is not likely to improve breast cancer survival rates for patients who do not have the BRCA mutation.
The 20 year mortality rate from a contralateral breast cancer is only 1% or less.
Contralateral prophylactic mastectomy is unlikely to be associated with any significant survival advantage for the general population of patients with unilateral breast cancer.
Similar survival for breast conserving surgery versus bilateral mastectomy indicates that preventing a second cancer in either breast, does not alter the mortality risk presented by the first cancer.
Benefit from risk reducing mastectomy is influenced by the patient’s baseline risk for metachronous contralateral breast cancer, and explains why it hereditary breast cancer susceptibility is associated with contralateral prophylactic mastectomy survival advantage.
In contrast to the above endocrine therapy for hormone receptor positive breast-cancer diminishes the risk of developing a new primary because of the chemoprevention effects of these agents.
In an analysis of 200,000 California cancer registry patients with unilateral non-metastatic breast cancer managed with conservative surgery in 55% of cases, bilateral mastectomy/CPM in 6%, and unilateral mastectomy in 39%: Median follow-up 89.1 months the 10 year survival for the 3 groups was 83.2%, 81.2%, and 79.9% respectively.
A BRCA associated unilateral breast cancer has an annual risk of 4% for a contralateral breast cancer, with a cumulative 10 year risk of contralateral breast cancer of about 40%.