Trends in the use of contralateral prophylactic mastectomy

Various patients, tumors, and treatment factors are signifi- cantly associated with CPM rates (Table 50.1). Younger women are much more likely to receive CPM (1,3). White race, higher education level, private health insurance, and family history of breast cancer have also been associated with higher CPM rates (1,3,5,7). In the SEER study, the presence of infiltrating lobular histology was one of the strongest predictors of CPM (1). Yet, recent studies indicate that the risk of contralateral breast cancer is not significantly increased for infiltrating lobular histology as compared with infiltrating ductal histology (10). Multicentric breast cancer has also been associated with higher CPM rates (11). BRCA testing is significantly associated with CPM, even among patients who do not have BRCA mutations. In one single-center study, the CPM rate was 40% among those patients who tested negative (12). Several studies have reported that preoperative MRI is associated with CPM (5,7,11). Patients treated at comprehensive cancer programs or teaching facilities are more likely to receive CPM (3).