Current Status of Contralateral Prophylactic Mastectomy: Investigating Structural Racial Disparity
Amulya Vadlakonda, Joanna Curry, Zihan Gao, Nikhil Chervu, Konmal Ali, Hanjoo Lee, Carlie K Thompson, Peyman Benharash- Surgery
Background:
Contralateral prophylactic mastectomy (CPM) remains a personal decision, influenced by psychosocial factors including cosmesis and peace of mind. While utilization of CPM is disproportionately low among Black patients, the degree to which these disparities are driven by patient- vs hospital-level factors remains unknown.
Study Design:
Patients undergoing mastectomy for non-metastatic ductal or lobular breast cancer were tabulated from the 2004-2020 National Cancer Database. The primary endpoint was receipt of CPM. Multivariable logistic regression models were constructed with interaction terms between Black-serving hospital (BSH) status and patient race to evaluate associations with CPM. Cox proportional hazard models were utilized to evaluate long-term survival.
Results:
Of 597,845 women studied, 70,911 (11.9%) were Black. Following multivariable adjustment, Black race (Adjusted Odds Ratio [AOR] 0.65, 95% Confidence Interval [CI] 0.64 – 0.67) and treatment at BSH (AOR 0.84, CI 0.83 – 0.85) were independently linked to lower odds of CPM. Although predicted probability of CPM was universally lower at higher BSH, Black patients faced a steeper reduction compared to White patients. Furthermore, receipt of CPM was linked to improved survival (HR 0.84, CI 0.83 – 0.86), while Black race was associated with a greater hazard ratio of 10-year mortality (HR 1.14, CI 1.12 – 1.17).
Conclusions:
Hospitals serving a greater proportion of Black patients are less likely to utilize CPM, suggestive of disparities in access to CPM at the institutional level. Further research and education are needed to characterize surgeon-specific and institutional practices in patient counseling and shared decision-making that shape disparities in access to CPM.