Results Summary

What was the research about?

Most women with cancer in one breast have a low risk of getting cancer in their other breast. But many women choose to have both breasts removed to prevent future breast cancers. Surgery to remove the healthy breast is called contralateral prophylactic mastectomy (CPM).

Researchers wanted to see how CPM affects a patient’s mental and social well-being. The research team compared two groups: patients who had both breasts removed and patients who had part or all of the breast with cancer removed but kept their healthy breast.

What were the results?

Compared with patients who kept the healthy breast, patients who had CPM had

  • More stress and suffering from their cancer before and after CPM
  • More concerns about body image before and after CPM
  • More worry about their cancer before CPM
  • The same amount of worry about their cancer after CPM
  • The same quality of life before CPM
  • A lower quality of life after CPM

Patients’ satisfaction with their treatment choice was the same for patients who had CPM and those who kept their healthy breast.

In interviews, patients said they worried about getting cancer again no matter which treatment they chose. Patients who had CPM said having both breasts removed gave them peace of mind.

A computer program predicted that CPM would have little effect on how long patients lived.

Who was in the study?

The study included 252 women from a cancer center and a community clinic in Houston, Texas. The patients were newly diagnosed with cancer in one breast. The cancer was not inherited. Among the patients, 55.5 percent had part of the breast with cancer removed, 27 percent had the whole breast with cancer removed, and 17.5 percent had both breasts removed (CPM). The average patient age was 56. Most patients in the study were white (57 percent), followed by African American (15 percent), Hispanic (15 percent), and other (8 percent).

What did the research team do?

The research team asked patients to fill out surveys before surgery and then again 1 month, 6 months, and 12 months after surgery. Patients rated their stress and suffering, body image concerns, worry about cancer, quality of life, and happiness with their treatment choice. The team used the survey results to find out how CPM and other treatments affected patients’ mental and social well-being over time. The research team also interviewed 20 of the patients about how their breast cancer diagnosis and treatment choice affected their lives.

The research team made a computer program to estimate survival rates in patients with cancer in one breast. The program used results from published studies to make estimates. The program considered the age at diagnosis, extent of the cancer, and history of breast cancer in the family.

What were the limits of the study?

Some patients didn’t fill out all the surveys. The results may not have been the same if the mental and social well-being of patients who didn’t fill out all the surveys was different from those who filled out all the surveys. The study was done in one large city; results may differ in smaller cities or rural areas. The research team recruited some patients after they were diagnosed with breast cancer but before they saw a surgeon. The team recruited the rest of the patients after they had seen a surgeon. These differences in recruiting may have affected the patients’ survey answers.

Future studies could look for ways to improve patients’ well-being after treatment for cancer in one breast. Studies could also test ways to tell doctors and patients about how treatments may affect mental and social well-being.

How can people use the results?

Women with breast cancer and their doctors can use the results of this study when deciding on treatment for cancer in one breast. 

Final Research Report

View this project's final research report.

Journal Citations

Article Highlight: Women with nonhereditary breast cancer who opted to have a contralateral prophylactic mastectomy (CPM) experienced higher levels of precancer surgery worry, compared with women who did not have the prophylactic surgery, according to researchers in this study. In a recent Journal of Clinical Oncology report the researchers noted, however, that postsurgery worry diminished over time and was similar to that of women who did not have a CPM. The researchers suggest that physicians might consider discussing pre- and postsurgery worry with their patients, which can be a key factor in decisions about whether to have a CPM. The study surveyed 288 women, including 50 who had CPM, and 238 who had a unilateral mastectomy or breast conserving surgery.

Stories and Videos

Peer-Review Summary

Peer review of PCORI-funded research helps ensure the report presents complete, balanced, and useful information about the research. It also confirms that the research has followed PCORI’s Methodology Standards. During peer review, experts who were not members of the research team read a draft report of the research. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. Reviewers do not have conflicts of interest with the study.

Peer reviewers point out where the draft report may need to be revised. For example, they may suggest ways to improve how the research team analyzed its results or reported its conclusions. Learn more about PCORI’s peer review process here.

In response to peer review, the PI made changes including

  • Providing additional information about how the investigators developed the model on which decision analyses were based 
  • Explaining that the variables in Aim 1 came from previous literature rather than a conceptual or theoretical framework. No such framework drove the research, so the study may be missing important ways that women with breast cancer differ from those without breast cancer
  • Updating the limitations section to acknowledge the lack of theoretical framework for the research, as well as the use of health state utility data from literature to adjust the decision analysis instead of obtaining the data from study participants in Aim 2. This choice was made to avoid increased burden on those participants
  • Clarifying that Aims 1 and 2 are separate studies by dividing the background, methods, and results sections to keep these studies separate

Conflict of Interest Disclosures

Project Information

Abenaa Brewster, MD*
University of Texas MD Anderson Cancer Center
Contralateral Prophylactic Mastectomy and Breast Cancer: Clinical and Psychosocial Outcomes

Key Dates

September 2013
July 2017

Study Registration Information

*Patricia A. Parker, PhD was the original principal investigator for this project.


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Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: January 20, 2023