Trend and survival benefit of contralateral prophylactic mastectomy among men with stage I-III unilateral breast cancer in the USA, 1998-2016

Yinlong Yang; Liangwei Pan; Zhiming Shao

doi:10.1007/s10549-021-06397-z

Trend and survival benefit of contralateral prophylactic mastectomy among men with stage I-III unilateral breast cancer in the USA, 1998-2016

Breast Cancer Res Treat. 2021 Dec;190(3):503-515. doi: 10.1007/s10549-021-06397-z. Epub 2021 Sep 23.

Authors

Yinlong Yang^#^{1

2}, Liangwei Pan^#^{3

4

5}, Zhiming Shao^{3

4}

Affiliations

¹ Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200000, China. lancetyang@126.com.
² Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200000, China. lancetyang@126.com.
³ Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200000, China.
⁴ Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200000, China.
⁵ Eight-Year Program Clinical Medicine, Grade of 2016, Shanghai Medical College, Fudan University, Shanghai, China.

^# Contributed equally.

PMID: 34554371
DOI: 10.1007/s10549-021-06397-z

Abstract

Purpose: Our study aimed to explore temporal trends and survival benefit of contralateral prophylactic mastectomy (CPM) in male breast cancer (MBC).

Methods: Men with stage I-III unilateral breast cancer between 1998 and 2016 were identified from the surveillance, epidemiology, and end results (SEER). We compared CPM rate over the study period using the Cochrane-Armitage test for trend. Logistic regression model was used to test for factors predicting CPM. Survival analysis was conducted in patients who underwent CPM or unilateral mastectomy (UM) with a first diagnosis of unilateral breast cancer. Kaplan-Meier curve and univariate and multivariable Cox proportional hazards regression analyses were performed to compare overall survival (OS) and breast cancer-specific survival (BCSS) between CPM and UM groups. Propensity score matching was adopted to balance baseline characteristics.

Results: 5118 MBC cases were included in the present study, with 4.1% (n = 209) patients underwent CPM. The proportion of men undergoing CPM increased from 1.7 in 1998 to 6.3% in 2016 (P < 0.0001). Young age, recent years of diagnosis, higher tumor grade and lower T stage were significantly associated with CPM. A cohort of 3566 patients were enrolled in survival analysis with a median follow-up of 65 months. CPM was associated with better OS (HR 0.58, 95% CI 0.37-0.89, P = 0.022) rather than BCSS (HR 0.57, 95% CI 0.29-1.11, P = 0.153) compared with UM. In propensity score-matched model, CPM was not an independent prognostic factor for OS (HR 0.83, 95% CI 0.46-1.52, P = 0.553) and BCSS (HR 0.98, 95% CI 0.39-2.47, P = 0.970).

Conclusion: Our study revealed a dramatic increase in CPM utilization among MBC, especially in young patients. However, CPM provides no survival benefit for MBC compared with UM, indicating the decision of CPM should be fully discussed.

Keywords: Contralateral prophylactic mastectomy; Male breast cancer; SEER; Survival; Trend.

MeSH terms

Breast Neoplasms* / epidemiology
Breast Neoplasms* / surgery
Breast Neoplasms, Male* / epidemiology
Breast Neoplasms, Male* / surgery
Humans
Male
Mastectomy
Prophylactic Mastectomy*
SEER Program
Unilateral Breast Neoplasms* / surgery
United States / epidemiology