title: Contralateral prophylactic mastectomy:  clinical and pathological features from a prospective database.
abstract: BACKGROUND
  In keeping with recently documented national trends, a significant and increasing number of patients will have chosen contralateral prophylactic mastectomy (CPM) based on personal preference, without traditional clinical or pathological indication.
  
  
  METHODS
  Women who underwent CPM at the University of Louisville from 2003 to 2009 were selected for this study. Descriptive factors were evaluated such as age, race, family history of breast cancer, laterality, hormone receptor status, stage, grade and histology of the index breast lesion. Statistical analysis was used to compute predictive factors for occult contralateral pathology.
  
  
  RESULTS
  A total of 107 patients underwent CPM and had adequate medical information to be included in this study. The median age was 48 years, with 88% being white and 12% being African American. Seventy-six percent of the index breast cancers were infiltrating ductal carcinoma and 12% were infiltrating lobular carcinoma. Five "significant" occult pathologies were found in the prophylactically removed breast. Two of the lesions were ductal carcinoma in situ, 2 were lobular carcinoma in situ and 1 was an invasive mucinous carcinoma. On bivariate analysis, there were no factors identified predictive for occult contralateral pathology.
  
  
  CONCLUSIONS
  In line with previously reported data, we noted that fewer than 5% of patients who underwent CPM had pathology in the contralateral breast. We were unable to correlate any clinical or pathological characteristics in women who presented with contralateral breast cancer. This study raises serious questions regarding the clinical utility of CPM in detecting synchronous clinically and radiographically occult contralateral primaries.
authors.affiliation: Departments of Radiation Oncology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Louisville, KY 40202, USA.
authors.forename: Parul N
authors.initials: PN
authors.lastname: Barry
authors.forename: Robert R
authors.initials: RR
authors.lastname: Johnson
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Harkenrider
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Freeman
authors.forename: Barbara
authors.initials: B
authors.lastname: Kruse
authors.forename: Mary R
authors.initials: MR
authors.lastname: Wilson
authors.forename: Jianmin
authors.initials: J
authors.lastname: Pan
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Dragun
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000517:prevention & control / Q000601:surgery*; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000517:prevention & control / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery; D018275:Carcinoma, Lobular / Q000473:pathology / Q000517:prevention & control / Q000601:surgery; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000706:statistics & numerical data / Q000639:trends*; D008875:Middle Aged; D057240:Patient Preference; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000706:statistics & numerical data / Q000639:trends