Predictors that influence contralateral prophylactic mastectomy election among women with ductal carcinoma in situ who were evaluated for BRCA genetic testing.

Abstract

Patients with ductal carcinoma in situ (DCIS) are at increased risk for developing contralateral breast cancer (CBC). Consequently, more women with DCIS are electing to undergo contralateral prophylactic mastectomy (CPM). We evaluated factors associated with CPM in patients with DCIS who underwent genetic counseling for BRCA testing. This retrospective study involved 165 women with DCIS referred for genetic counseling between 2003 and 2011. Patient characteristicswere age, marital and educational status, tumor markers, nuclear grade, family history of breast cancer (BC) and ovarian cancer (OC), race, Ashkenazi Jewish ancestry, and BRCA results. Univariate and multivariate logistic regression analyses were used to determine predictive factors associated with CPM election. Of 165 patients, 44 (27%) underwent CPM. Patients <45years of age were more likely to elect CPM (p=0.0098). A BRCA+ mutation was found in 17 patients (10.3%), and BRCA+ women were more likely to elect CPM than BRCA or untested women (p=0.0001). Patients who had a family history of OC (57.7%) were more likely to choose CPM than those with no family history (p=0.0004). Younger age, BRCA+, and an OC family history remained significant in the multivariate model (p<0.008). The CPM rate among patients with DCIS who undergo genetic counseling is high. Factors associated with increased likelihood of CPM among this group were age, BRCA+, and a family history of OC. Further studies are needed to evaluate patients' perceptions of CBC risk and their role in the likelihood of CPM choice.