title: Improved long-term survival with contralateral prophylactic mastectomy among young women.
abstract: BACKGROUND
  Despite mixed survival data, the utilization of contralateral prophylactic mastectomy (CPM) for the prevention of a contralateral breast cancer (CBC) has increased significantly over the last 15 years, especially among women less than 40. We set out to look at our own experience with CPM, focusing on outcomes in women less than 40, the sub-population with the highest cumulative lifetime risk of developing CBC. With an extended follow-up, we hoped to demonstrate differences in the long-term disease free survival (DFS) and overall survival (OS) among groups who underwent the procedure (CPM) versus those that did not (NCPM).
  
  
  METHODS
  We performed a retrospective review of all breast cancer patients less than age 40 diagnosed at Mount Sinai Medical Center between January 1, 1980 and December 31, 2010 (n=481). Among these patients, 42 were identified as having undergone CPM, while 195 were confirmed as being CPM-free during the observation period. A univariate and multivariate analyses were performed.
  
  
  RESULTS
  The CPM group had a significantly higher percentage of patients who were diagnosed between 2000 and 2010 (95.2% vs 40%, p=0.0001). The CPM group had significantly smaller tumors (0-2cm.: 41.7% vs 24.8%, p=0.04). Among the entire group of patients, the overall five- and 10-year DFS were 81.3% and 73.3%, respectively. CPM was significantly associated [HR 2.35 (1.02, 5.41); p=0.046] with 10-year OS, although a similar effect was not observed for five-year OS.
  
  
  CONCLUSIONS
  We found that CPM has increased dramatically over the last 15 years, especially among white women with locally advanced disease. In patients less than 40, who are thought to be at greatest cumulative risk of secondary breast cancer, CPM provided an OS advantage, regardless of genetics, tumor or patient characteristics, and which was only seen after 10 years of follow-up.
authors.affiliation: Department of Internal Medicine, Mount Sinai Medical Center E-mail : simonzeichner@gmail.com.
authors.forename: Simon Blechman
authors.initials: SB
authors.lastname: Zeichner
authors.forename: Simon Blechman
authors.initials: SB
authors.lastname: Zeichner
authors.forename: Ana Lourdes
authors.initials: AL
authors.lastname: Ruiz
authors.forename: Nathan Joseph
authors.initials: NJ
authors.lastname: Markward
authors.forename: Estelamari
authors.initials: E
authors.lastname: Rodriguez
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000401:mortality* / Q000517:prevention & control / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000706:statistics & numerical data*; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; C508053:ERBB2 protein, human