Contralateral Mastectomy After Unilateral Breast Cancer
Contralateral Mastectomy After Unilateral Breast Cancer
CPM may hold benefits for UBC patients with elevated FGR for MCBC, but on the basis of the findings of our meta-analysis, its use is not justified in breast cancer patients not otherwise at elevated risk for developing MCBC. Even among the subset of high-risk patients with elevated FGR, CPM is associated with decreased MCBC incidence but not with improved survival. The temporal and financial challenges of conducting an RCT on CPM will likely preclude one from ever being conducted; postenrollment periods of at least 10 or 20 years would be required to allow for substantive accumulation of breast cancer events, and it would be difficult, if not impossible, to achieve that degree of longitudinal observation in retrospective analyses from single or even multiple institutions. Accordingly, the contribution of our study, the only quantitative summation of the literature on CPM, is significant: we have demonstrated that, given the minimal decrease in MCBC risk conferred by CPM in the general population of UBC patients, CPM should not be offered to those whose FGR does not otherwise place them at high risk for MCBC.
Conclusions
CPM may hold benefits for UBC patients with elevated FGR for MCBC, but on the basis of the findings of our meta-analysis, its use is not justified in breast cancer patients not otherwise at elevated risk for developing MCBC. Even among the subset of high-risk patients with elevated FGR, CPM is associated with decreased MCBC incidence but not with improved survival. The temporal and financial challenges of conducting an RCT on CPM will likely preclude one from ever being conducted; postenrollment periods of at least 10 or 20 years would be required to allow for substantive accumulation of breast cancer events, and it would be difficult, if not impossible, to achieve that degree of longitudinal observation in retrospective analyses from single or even multiple institutions. Accordingly, the contribution of our study, the only quantitative summation of the literature on CPM, is significant: we have demonstrated that, given the minimal decrease in MCBC risk conferred by CPM in the general population of UBC patients, CPM should not be offered to those whose FGR does not otherwise place them at high risk for MCBC.
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