title: Predictors for contralateral prophylactic mastectomy in breast cancer patients.
abstract: BACKGROUND
  In recent years, radical breast cancer surgery has been largely replaced by breast conservation treatment, due to early diagnosis and more effective adjuvant treatment. While breast conservation is mostly preferred, the trend of bilateral mastectomy has risen in the United States. The aim of this study is to determine factors influencing patients' choice for having contralateral prophylactic mastectomy (CPM).
  
  
  METHODS
  This is a retrospective study of 373 patients diagnosed with primary invasive breast cancer who were treated by bilateral or unilateral mastectomy (BM or UM) at the Revlon/UCLA Breast Center between Jan. 2002 and Dec. 2010. In the BM group, only those with unilateral breast cancer who chose CPM were included in the analysis.
  
  
  RESULTS
  When compared with the UM group, the following factors were found to be associated with BM: younger age, pre-menopausal, a family history of breast/ovarian cancer, BRCA mutation, more breast biopsies, history of breast augmentation, having MRI study within 6 months before the surgery, more likely to have reconstruction and sentinel lymph node biopsy (SLNB) and fewer had neoadjuvant/adjuvant chemotherapy/radiation. When patients with bilateral breast cancer were excluded, multivariate logistic regression analysis indicated younger patients with negative nodes, SLNB as the only nodal surgery and positive family history were significant factors predicting CPM and immediate reconstruction using tissue expanders or implants.
  
  
  CONCLUSIONS
  Younger age, lower TN stage, requiring only SLNB and high risk family history predict contralateral prophylactic mastectomy. Tissue expander/implant-based reconstructions were more frequently chosen by patients with BM.
authors.affiliation: Department of Surgery, Revlon/UCLA Breast Center, David Geffen School of Medicine, University of California of Los Angeles Los Angeles, United States ; Department of Breast Surgery, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine Shanghai, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Fu
authors.affiliation: Department of Breast Surgery, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine Shanghai, China.
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Zhuang
authors.affiliation: Department of Surgery, Revlon/UCLA Breast Center, David Geffen School of Medicine, University of California of Los Angeles Los Angeles, United States.
authors.forename: Michelle
authors.initials: M
authors.lastname: Dewing
authors.affiliation: Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA Los Angeles, CA, United States.
authors.forename: Sophia
authors.initials: S
authors.lastname: Apple
authors.affiliation: Department of Surgery, Revlon/UCLA Breast Center, David Geffen School of Medicine, University of California of Los Angeles Los Angeles, United States.
authors.forename: Helena
authors.initials: H
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019313:BRCA1 Protein / Q000235:genetics*; D001943:Breast Neoplasms / Q000235:genetics / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000235:genetics / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D065286:Prophylactic Surgical Procedures; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D019313:BRCA1 Protein
keywords: BRCA mutation; Breast cancer; bilateral mastectomy; contralateral prophylactic mastectomy; predictors