title: Contralateral prophylactic mastectomy provides no survival benefit in young women with estrogen receptor-negative breast cancer.
abstract: BACKGROUND
  Several studies have shown that contralateral prophylactic mastectomy (CPM) provides a disease-free and overall survival (OS) benefit in young women with estrogen receptor (ER)-negative breast cancer. We utilized the National Cancer Data Base to evaluate CPM's survival benefit for young women with early -stage breast cancer in the years that ER status was available.
  
  
  METHODS
  We selected 14,627 women ≤45 years of age with American Joint Committee on Cancer stage I-II breast cancer who underwent unilateral mastectomy or CPM from 2004 to 2006. Five-year OS was compared between those who had unilateral mastectomy and CPM using the Kaplan-Meier method and Cox regression analysis.
  
  
  RESULTS
  A total of 10,289 (70.3 %) women underwent unilateral mastectomy and 4,338 (29.7 %) women underwent CPM. Median follow up was 6.1 years. After adjusting for patient age, race, insurance status, co-morbidities, year of diagnosis, ER status, tumor size, nodal status, grade, histology, facility type, facility location, use of adjuvant radiation and chemohormonal therapy, there was no difference in OS in women <45 years of age who underwent CPM compared towith those who underwent unilateral mastectomy (hazard ratio [HR] = 0.93; p = 0.39). In addition, Tthere was no improvement in OS in women <45 years of age with T1N0 tumors who underwent CPM versus unilateral mastectomy (HR = 0.85; p = 0.37) after adjusting for the aforementioned factors. Among women ≤45 years of age with ER-negative tumors who underwent CPM, there was no improvement in OS compared with women who underwent unilateral mastectomy (HR = 1.12; p = 0.32) after adjusting for the same aforementioned factors.
  
  
  CONCLUSIONS
  CPM provides no survival benefit to young patients with early-stage breast cancer, and no benefit to ER-negative patients. Future studies with longer follow-up are required in this cohort of patients.
authors: Department of Surgery, NorthShore University Health System, Evanston, IL, USA, CPesce@northshore.org.
authors: Catherine
authors: C
authors: Pesce
authors: Erik
authors: E
authors: Liederbach
authors: Chihsiung
authors: C
authors: Wang
authors: Brittany
authors: B
authors: Lapin
authors: David J
authors: DJ
authors: Winchester
authors: Katharine
authors: K
authors: Yao
mesh_terms: D000293:Adolescent; D000328:Adult; D001943:Breast Neoplasms / Q000378:metabolism / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000378:metabolism / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D018275:Carcinoma, Lobular / Q000378:metabolism / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy / Q000401:mortality*; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D011960:Receptors, Estrogen / Q000378:metabolism*; D018426:SEER Program; D015983:Selection Bias; D015996:Survival Rate; D055815:Young Adult
chemical_list: D011960:Receptors, Estrogen