Contralateral prophylactic mastectomy after unilateral breast cancer: A systematic review and meta-analysis

Oluwadamilola Motunaryo Fayanju, Carolyn R.T. Stoll, Susan Fowler, Graham A. Colditz, Julie A. Margenthaler

Research output: Contribution to journalReview articlepeer-review

73 Scopus citations

Abstract

Objective: To examine whether contralateral prophylactic mastectomy (CPM) is associated with improved survival, incidence of contralateral breast cancer (CBC), and recurrence in patients with unilateral breast cancer (UBC). Background: Despite conflicting data, CPM rates continue to increase. Here we present the first meta-analysis to assess post-CPM outcomes in women with UBC. Methods: We searched 5 databases and retrieved papers' bibliographies for relevant studies published through March 2012. Fixed- and random-effects meta-analyses were conducted on the basis of tests of study heterogeneity. We examined potential confounding via stratification and meta-regression. We report pooled relative risks (RRs) and risk differences (RDs) with 95% confidence intervals (CIs) at 2-tailed P < 0.05 significance. Results: Of 93 studies reviewed, 14 were included in meta-analyses. Compared with nonrecipients, CPM recipients had higher rates of overall survival [OS; RR=1.09 (95% CI: 1.06, 1.11)] and lower rates of breast cancer-specific mortality [BCM; RR = 0.69 (95% CI: 0.56, 0.85)] but saw no absolute reduction in risk of metachronous CBC (MCBC). Among patients with elevated familial/genetic risk (FGR, ie, BRCA carrier status and/or family history of breast cancer), both relative and absolute risks of MCBC were significantly decreased among CPM recipients [RR = 0.04 (95% CI: 0.02, 0.09); RD = -24.0% (95% CI: -35.6%, -12.4%)], but there was no improvement in OS or BCM. Conclusions: CPM is associated with decreased MCBC incidence but not improved survival among patients with elevated FGR. The superior outcomes observed when comparing CPM recipients with nonrecipients in the general population are likely not attributable to a CPM-derived decrease in MCBC incidence.UBCpatients without known FGR should not be advised to undergo CPM.

Original languageEnglish
Pages (from-to)1000-1010
Number of pages11
JournalAnnals of surgery
Volume260
Issue number6
DOIs
StatePublished - 2014

Keywords

  • Breast cancer
  • Mastectomy
  • Meta-analysis
  • Prevention and control
  • Systematic review

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