Association between contralateral prophylactic mastectomy and breast cancer outcomes by hormone receptor status

BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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. The study examined the association between contralateral prophylactic mastectomy and disease‐free and overall survival in a large cohort of patients with early‐stage breast cancer, applying the propensity score method to reduce the impact of selection bias. Contralateral prophylactic mastectomy was associated with improved disease‐free survival for some patients with hormone receptor–negative breast cancer, suggesting that certain subsets of patients may be more likely to benefit from the procedure than others.