title: Contralateral mastectomy and survival after breast cancer in carriers of BRCA1 and BRCA2 mutations: retrospective analysis.
abstract: OBJECTIVE
  To compare the survival rates of women with BRCA associated breast cancer who did and did not undergo mastectomy of the contralateral breast.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  12 cancer genetics clinics.
  
  
  METHODS
  390 women with a family history of stage I or II breast cancer who were carriers of BRCA1 and BRCA2 mutations and initially treated with unilateral or bilateral mastectomy. 181 patients had mastectomy of the contralateral breast. Patients were followed for up to 20 years from diagnosis.
  
  
  METHODS
  Death from breast cancer.
  
  
  RESULTS
  79 women died of breast cancer in the follow-up period (18 in the bilateral mastectomy group and 61 in the unilateral mastectomy group). The median follow-up time was 14.3 years (range 0.1-20.0 years). At 20 years the survival rate for women who had mastectomy of the contralateral breast was 88% (95% confidence interval 83% to 93%) and for those who did not was 66% (59% to 73%). In a multivariable analysis, controlling for age at diagnosis, year of diagnosis, treatment, and other prognostic features, contralateral mastectomy was associated with a 48% reduction in death from breast cancer (hazard ratio 0.52, 95% confidence interval 0.29 to 0.93; P=0.03). In a propensity score adjusted analysis of 79 matched pairs, the association was not significant (0.60, 0.34 to 1.06; P=0.08). Based on these results, we predict that of 100 women treated with contralateral mastectomy, 87 will be alive at 20 years compared with 66 of 100 women treated with unilateral mastectomy.
  
  
  CONCLUSIONS
  This study suggests that women who are positive for BRCA mutations and who are treated for stage I or II breast cancer with bilateral mastectomy are less likely to die from breast cancer than women who are treated with unilateral mastectomy. Given the small number of events in this cohort, further research is required to confirm these findings.
authors: Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Canada.
authors: Kelly
authors: K
authors: Metcalfe
authors: Shelley
authors: S
authors: Gershman
authors: Parviz
authors: P
authors: Ghadirian
authors: Henry T
authors: HT
authors: Lynch
authors: Carrie
authors: C
authors: Snyder
authors: Nadine
authors: N
authors: Tung
authors: Charmaine
authors: C
authors: Kim-Sing
authors: Andrea
authors: A
authors: Eisen
authors: William D
authors: WD
authors: Foulkes
authors: Barry
authors: B
authors: Rosen
authors: Ping
authors: P
authors: Sun
authors: Steven A
authors: SA
authors: Narod
mesh_terms: D000328:Adult; D019313:BRCA1 Protein / Q000235:genetics* / Q000378:metabolism; D024682:BRCA2 Protein / Q000235:genetics* / Q000378:metabolism; D001943:Breast Neoplasms / Q000235:genetics / Q000401:mortality / Q000601:surgery*; D002170:Canada / Q000453:epidemiology; D004273:DNA, Neoplasm / Q000235:genetics*; D005260:Female; D005544:Forecasting; D006801:Humans; D008408:Mastectomy / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D009154:Mutation; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human; D004273:DNA, Neoplasm