Abstract Background: The rate of patients undergoing contralateral prophylactic mastectomy (CPM) for unilateral breast cancer has been rising dramatically despite emerging guidelines which discourage CPM in low-risk patients due to lack of survival benefit. The decision to undergo CPM is personal and often multi-factorial, and has not been well-studied. This study aimed to identify clinical and sociological factors associated with the decision to pursue CPM in an urban, underserved community. Methods: A retrospective review of 259 patients with unilateral breast cancer who underwent mastectomy from 2012-2025 at a tertiary care hospital system was performed. Variables included sociodemographic and clinical features. Primary outcome was rate of CPM. Statistical analyses were performed in SPSS. Results: Total rate of CPM in our population was 29% (n=75) and total rate of reconstruction was 18% (n=47). No male patients (n=9) underwent CPM, whereas rate of CPM in female patients was 30% (p=0.0627). Among female patients, patients who underwent CPM were on average 13.6 years younger than controls (p 0.001). Having private insurance vs. public insurance (p=0.084) and being currently employed vs. unemployed (p=0.073) trended towards significance for association with CPM. Among clinical factors, undergoing surgical reconstruction (p=0.002), and undergoing neoadjuvant chemotherapy (p=0.001) were associated with CPM. There was no significant association between CPM and racial or ethnic group, tumor size, histologic subtype, clinical stage, or hormone receptor positivity. Conclusion: In our urban population, social factors such as age, insurance status, and employment status and whether patients additionally underwent surgical reconstruction or neoadjuvant treatment with chemotherapy may play a role in the decision to undergo CPM. In management of patients with unilateral breast cancer, surgeons may consider such nuances in patient decision-making when guiding conversations surrounding CPM. Citation Format: A. D. Simoni, R. Greenbaum, S. Harbour, S. L. Jao, M. P. McEvoy. Assessing Clinical and Sociodemographic Trends in Contralateral Prophylactic Mastectomy at an Urban Tertiary Care Center abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-10-23.
Simoni et al. (Tue,) studied this question.