Pamela R Portschy1, Karen M Kuntz1, Todd M Tuttle2. 1. Affiliations of authors: Department of Surgery (PRP, TMT) and Division of Health Policy and Management (KMK), University of Minnesota, Minneapolis, MN. 2. Affiliations of authors: Department of Surgery (PRP, TMT) and Division of Health Policy and Management (KMK), University of Minnesota, Minneapolis, MN. tuttl006@umn.edu.
Abstract
BACKGROUND: Contralateral prophylactic mastectomy (CPM) rates have substantially increased in recent years and may reflect an exaggerated perceived benefit from the procedure. The objective of this study was to evaluate the magnitude of the survival benefit of CPM for women with unilateral breast cancer. METHODS: We developed a Markov model to simulate survival outcomes after CPM and no CPM among women with stage I or II breast cancer without a BRCA mutation. Probabilities for developing contralateral breast cancer (CBC), dying from CBC, dying from primary breast cancer, and age-specific mortality rates were estimated from published studies. We estimated life expectancy (LE) gain, 20-year overall survival, and disease-free survival with each intervention strategy among cohorts of women defined by age, estrogen receptor (ER) status, and stage of cancer. RESULTS: Predicted LE gain from CPM ranged from 0.13 to 0.59 years for women with stage I breast cancer and 0.08 to 0.29 years for those with stage II breast cancer. Absolute 20-year survival differences ranged from 0.56% to 0.94% for women with stage I breast cancer and 0.36% to 0.61% for women with stage II breast cancer. CPM was more beneficial among younger women, stage I, and ER-negative breast cancer. Sensitivity analyses yielded a maximum 20-year survival difference with CPM of only 1.45%. CONCLUSIONS: The absolute 20-year survival benefit from CPM was less than 1% among all age, ER status, and cancer stage groups. Estimates of LE gains and survival differences derived from decision models may provide more realistic expectations of CPM.
BACKGROUND: Contralateral prophylactic mastectomy (CPM) rates have substantially increased in recent years and may reflect an exaggerated perceived benefit from the procedure. The objective of this study was to evaluate the magnitude of the survival benefit of CPM for women with unilateral breast cancer. METHODS: We developed a Markov model to simulate survival outcomes after CPM and no CPM among women with stage I or II breast cancer without a BRCA mutation. Probabilities for developing contralateral breast cancer (CBC), dying from CBC, dying from primary breast cancer, and age-specific mortality rates were estimated from published studies. We estimated life expectancy (LE) gain, 20-year overall survival, and disease-free survival with each intervention strategy among cohorts of women defined by age, estrogen receptor (ER) status, and stage of cancer. RESULTS: Predicted LE gain from CPM ranged from 0.13 to 0.59 years for women with stage I breast cancer and 0.08 to 0.29 years for those with stage II breast cancer. Absolute 20-year survival differences ranged from 0.56% to 0.94% for women with stage I breast cancer and 0.36% to 0.61% for women with stage II breast cancer. CPM was more beneficial among younger women, stage I, and ER-negative breast cancer. Sensitivity analyses yielded a maximum 20-year survival difference with CPM of only 1.45%. CONCLUSIONS: The absolute 20-year survival benefit from CPM was less than 1% among all age, ER status, and cancer stage groups. Estimates of LE gains and survival differences derived from decision models may provide more realistic expectations of CPM.
Authors: Shoshana M Rosenberg; Karen Sepucha; Kathryn J Ruddy; Rulla M Tamimi; Shari Gelber; Meghan E Meyer; Lidia Schapira; Steven E Come; Virginia F Borges; Mehra Golshan; Eric P Winer; Ann H Partridge Journal: Ann Surg Oncol Date: 2015-05-01 Impact factor: 5.344
Authors: J E Squires; D Stacey; M Coughlin; M Greenough; A Roberts; K Dorrance; M Clemons; J M Caudrelier; I D Graham; J Zhang; M Demery Varin; A Arnaout Journal: Curr Oncol Date: 2019-04-01 Impact factor: 3.677
Authors: Nicole Christian; Emily C Zabor; Michael Cassidy; Jessica Flynn; Monica Morrow; Mary L Gemignani Journal: Ann Surg Oncol Date: 2019-11-15 Impact factor: 5.344
Authors: Peter Angelos; Isabelle Bedrosian; David M Euhus; Virginia M Herrmann; Steven J Katz; Andrea Pusic Journal: Ann Surg Oncol Date: 2015-08-11 Impact factor: 5.344
Authors: Rachel A Freedman; Elena M Kouri; Dee W West; Shoshana Rosenberg; Ann H Partridge; Joyce Lii; Nancy L Keating Journal: Clin Breast Cancer Date: 2015-08-28 Impact factor: 3.078