Contralateral Prophylactic Mastectomies for Early Stage Invasive Breast Cancer Vary by State

Although CPM rates went higher in all states, the size of the increase varied considerably across states.
Although CPM rates went higher in all states, the size of the increase varied considerably across states.

The proportion of women with invasive early-stage unilateral breast cancer electing to undergo contralateral prophylactic mastectomy (CPM) has increased significantly over the previous decade in the United States even though evidence does not support any survival benefit. In addition, this trend varies considerably across states.1

This retrospective cohort study examined variation by state in the temporal trend and proportion of CPMs in women with early-stage unilateral breast cancer who underwent surgery.

Among more than 1.2 million women 20 years or older with invasive early-stage breast cancer treated with surgery between January 2004 and December 2012 in 45 states and the District of Columbia, overall rates of CPM increased from 3.6% in 2004 to 10.4% in 2012 in women 45 years or older and from 10.5% to 33.3% in women between 20 and 44 years. The North American Association of Central Cancer Registries compiled the data.

While the increased rate of CPMs occurred in all states, the size of the increase varied considerably across states. In women 20 to 44 years, the percentage who underwent CPM from 2004-2006 to 2010-2012 rose from 14.9% to 24.8% in New Jersey compared to 9.8% to 32.3% in Virginia.

In the 20-to-44-years age group, CPM rates from 2010 to 2012 were greater than 42% in the 5 contiguous states of Nebraska, Missouri, Colorado, Iowa, and South Dakota.

While the percentage of women with invasive early-stage unilateral breast cancer aged 20 to 44 years who underwent reconstructive surgical procedures increased, these increases did not correlate with the proportion of women who underwent CPM.

Reference

1. Nash R, Goodman M, Lin CC, et al. State variation in the receipt of a contralateral prophylactic mastectomy among women who received a diagnosis of invasive unilateral early-stage breast cancer in the United States, 2004-2012. JAMA Surg. 2017 Mar 29. doi: 10.1001/jamasurg.2017.0115. [Epub ahead of print]

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