Contralateral Prophylactic Mastectomy: Impact of Racial Disparities

By: Bryna Goeking
Posted: Monday, May 20, 2024

Contralateral prophylactic mastectomy is a personal decision that is influenced by a host of factors, including cosmesis and peace of mind. A recent study conducted by Peyman Benharash, MD, FACS, of the University of California, Los Angeles, and colleagues found that the use of this surgical strategy is disproportionately low among Black patients and within Black-serving hospitals. The study findings were published in the Journal of the American College of Surgeons following its presentation at the 2024 Annual Scientific Meeting of the Southern California Chapter of the American College of Surgeons.

“Across the 17-year study period, we noted persistent racial disparities at the patient- and hospital-level in the utilization of contralateral prophylactic mastectomy,” the authors said.

The investigators reported that they identified a connection between contralateral prophylactic mastectomy and improvement in survival (hazard ratio [HR] = 0.84, confidence interval [CI] = 0.83–0.86). Black race was associated with a greater hazard of 10-year mortality (HR = 1.14, CI = 1.12–1.17). “Following multivariable adjustment, Black race (adjusted odds ratio [AOR] = 0.65, 95% CI = 0.64–0.67) and treatment at Black-serving hospitals (AOR = 0.84, CI = 0.83–0.85) were independently linked to lower odds of contralateral prophylactic mastectomy,” they wrote.

This study focused on the use of contralateral prophylactic mastectomy among a national cohort of patients. Of the 597,845 women in the 2004 to 2020 database, nearly 12% of women (n = 70,911) were Black. The authors acknowledged that contralateral prophylactic mastectomy remains a controversial treatment method because of its removal of healthy tissues.

“Any blanket recommendation about contralateral prophylactic mastectomy ignores the nuanced and deeply personal nature about the decision to pursue contralateral prophylactic mastectomy,” they concluded.

Disclosure: For full disclosures of the study authors, visit journals.lww.com.

Journal of the American College of Surgeons