Contralateral prophylactic mastectomy and its association with reduced mortality: evidence for selection bias

Ismail Jatoi, Helen M. Parsons

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Contralateral prophylactic mastectomy (CPM) refers to removal of the opposite uninvolved breast in women with unilateral breast cancer, and rates are increasing worldwide. In observational studies, CPM is often associated with reductions in breast cancer-specific and all-cause mortality when compared to unilateral surgical treatment alone, but this may reflect selection of a healthier cohort for CPM (selection bias). To further explore this possibility, we examined the association between CPM and non-cancer mortality, an indicator of selection bias. We identified 449,178 adult women diagnosed with unilateral, primary American Joint Committee on Cancer (AJCC) stage I–III ductal or lobular breast cancer, utilizing the 1998–2010 Surveillance, Epidemiology, and End Results dataset. Of these, 5.8 % (n = 25,961) underwent CPM as their first course of treatment. We examined associations between CPM and breast cancer-specific, all-cause, and non-cancer mortality utilizing multivariate logistic regression, adjusting for age, race, AJCC stage, estrogen receptor status, progesterone receptor status, and histologic grade of the tumor. Among all patients receiving CPM as first course of treatment, CPM was associated with lower breast cancer-specific [HR 0.84 (95 % CI 0.79–0.89)], all-cause [HR 0.83 (95 % CI 0.80–0.88)], and non-cancer [HR 0.71 (95 % CI 0.64–0.80)] 5-year hazard of death. Although our results are consistent with other observational studies showing associations between CPM and reductions in breast cancer-specific and all-cause mortality, we demonstrate an even stronger association between CPM and reduced non-cancer mortality. Thus, the reported associations between CPM and reductions in mortality might at least partly be attributable to selection bias.

Original languageEnglish (US)
Pages (from-to)389-396
Number of pages8
JournalBreast Cancer Research and Treatment
Issue number2
StatePublished - Nov 7 2014

Bibliographical note

Funding Information:
Funding Dr. Parsons is supported by grant K07CA175063 from the U.S. National Cancer Institute.

Publisher Copyright:
© 2014, Springer Science+Business Media New York.

Copyright 2016 Elsevier B.V., All rights reserved.


  • Breast cancer
  • Contralateral prophylactic mastectomy
  • Mortality

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