Choosing contralateral prophylactic mastectomy for unilateral breast cancer in an urban South African breast cancer clinic

Abstract

Abstract Background: International trends have shown that female patients with unilateral breast cancer are electing bilateral mastectomies as a prophylactic measure. The study aimed to determine the prevalence of unilateral mastectomies (UM) with and without contralateral prophylactic mastectomy (CPM) and to identify whether demographic and pathological characteristics predict the choice of CPM. Methods: A record review of demographic details and pathological results of all female patients undergoing mastectomy for unilateral breast cancer from 2013-2015 was conducted at the Helen Joseph Breast Care Clinic in Johannesburg, South Africa. Results: A total of 299 women who had mastectomies for unilateral breast cancer were included in the study. Of these, 59 had CPM (19.7%). Significantly more White women opted for a CPM than Black women (43.5% vs 10.6%, p♯αμπ;λτ;0.0001). Women who underwent CPM were significantly younger, and there was a trend for higher median breast weight than patients who only underwent UM (p = 0.03 and p = 0.09, respectively). There was no difference between the two groups with regard to patient income status, tumour histology, TNM stage or neoadjuvant chemotherapy. Conclusion: The demographic and histopathological characteristics of breast cancer which influence the choice of CPM in the South African context have some similarities to those in the international literature in that White and younger women more often choose CPM compared to other racial groups. The more advanced stages of breast cancer presentation in our study suggest that public health awareness and screening measures need to be significantly strengthened in South Africa.