The use of contralateral prophylactic mastectomy has increased among men diagnosed with unilateral breast cancer, according to study results published in JAMA Surgery.
Further, contralateral prophylactic mastectomy (CPM) occurred more frequently among younger patients, white men and patients with private insurance, the researchers reported.
“Previous studies have reported marked increases in the rates of CPM among U.S. women who received a diagnosis of unilateral invasive breast cancer, and this increase is particularly evident among younger women,” Ahmedin Jemal, DVM, PhD, vice president of surveillance research at American Cancer Society, and colleagues wrote. “This increase has occurred despite the lack of evidence for a survival benefit from bilateral surgery, in addition to complications and associated costs.”
Jemal and colleagues conducted a nationwide population-based study to examine the temporal trends in and factors associated with CPM use among men diagnosed with unilateral invasive breast cancer.
Using the North American Association of Central Cancer Registries, the researchers identified 6,332 men aged 20 years or older who underwent surgery for stage I to stage III unilateral breast cancer between 2004 and 2011. They stratified their analyses based on type of surgery, race/ethnicity, insurance status, tumor grade and tumor size.
Overall, 75.8% of men (n = 4,800) underwent unilateral mastectomy, 19.8% (n = 1,254) underwent breast-conserving surgery and 4.4% (n = 278) underwent bilateral mastectomy.
The rate of CPM increased 86.7% between 2004-2005 and 2010-2011, or from 3% to 5.6% (P < .001). The CPM rate monotonically decreased with age, from 16.5% for men aged 20 to 39 years, to 6.9% for men aged 50 to 59 years, and to 1.4% for men aged 70 years or older (P < .001).
Factors associated with a greater likelihood for CPM included younger age (adjusted OR [aOR] for 20 to 39 years vs. ≥ 70 years = 15.3; 95% CI, 7.7-30.4), white race (aOR = 0.6; 95% CI, 0.4-0.9) and private insurance (aOR = 0.5; 95% CI, 0.2-1).
The researchers acknowledged their inability to ascertain whether the increase in CPM among men corresponded with genetic testing or MRI receipt, factors which have been associated with the increase in CPM among women.
“Ironically, the increase in the rate of CPM, a costly procedure without a survival benefit, is unfolding in the face of a greater emphasis on value in cancer care,” Jemal and colleagues wrote. “Health care professionals should be aware that the trends in CPM are not limited to women alone, and clinicians should educate male patients about the existing evidence of the benefit, harm, and cost of CPM in order to help patients make informed decisions about their treatment.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.