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Association between contralateral prophylactic mastectomy and breast cancer outcomes by hormone receptor status†
Article first published online: 19 APR 2012
Copyright © 2012 American Cancer Society
Volume 118, Issue 22, pages 5637–5643, 15 November 2012
How to Cite
Brewster, A. M., Bedrosian, I., Parker, P. A., Dong, W., Peterson, S. K., Cantor, S. B., Crosby, M. and Shen, Y. (2012), Association between contralateral prophylactic mastectomy and breast cancer outcomes by hormone receptor status. Cancer, 118: 5637–5643. doi: 10.1002/cncr.27574
Erica Goodoff of The MD Anderson Cancer Center Department of Scientific Publications provided editorial assistance.
Fax: (713) 563-5746
- Issue published online: 30 OCT 2012
- Article first published online: 19 APR 2012
- Manuscript Accepted: 5 MAR 2012
- Manuscript Revised: 30 JAN 2012
- Manuscript Received: 29 NOV 2011
- prophylactic mastectomy;
- breast cancer;
- hormone receptor status;
- propensity score analysis
The effect of contralateral prophylactic mastectomy (CPM) on the survival of patients with early-stage breast cancer remains controversial. The objective of this study was to evaluate the benefits of CPM using a propensity scoring approach that reduces selection bias from the nonrandom assignment of patients in observational studies.
A total of 3889 female patients with stage I to III breast cancer were identified who were treated at The University of Texas MD Anderson Cancer Center from 1997 to 2009. We assessed the association between CPM and disease-free (DFS) and overall survival (OS), by using Cox proportional hazards models to estimate hazard ratios (HRs), and by matching patients in the CPM and no-CPM groups using propensity scores (n = 497 pairs).
With a median follow-up time of 4.5 years, CPM was associated with improved DFS (HR, 0.75; 95% confidence interval [CI], 0.59-0.97) and OS (HR, 0.74; 95% CI, 0.56-0.99), adjusted for prognostic factors. The improved DFS was seen predominantly among hormone receptor–negative (HR, 0.60; 95% CI, 0.38-0.95) compared with hormone receptor–positive patients (HR, 0.80; 95% CI, 0.58-1.10). For the matched patient cohort, stratified survival analysis also showed an improvement in DFS with CPM (HR, 0.48; 95% CI, 0.22-1.01) in hormone receptor–negative patients that was nearly statistically significant.
CPM was associated with improved DFS for some patients with hormone receptor–negative breast cancer, after reducing selection bias. Identifying subsets of patients most likely to benefit from CPM may have important implications for a more personalized approach to treatment decisions about CPM. Cancer 2012. © 2012 American Cancer Society.