Contralateral Prophylactic Mastectomy In Women Research Articles

Current knowledge on contralateral prophylactic mastectomy among women with sporadic breast cancer.

The use of contralateral prophylactic mastectomy (CPM) in the U.S. among patients with unilateral invasive breast cancer increased by 150% from 1993 to 2003. Although CPM has been shown to reduce the risk for developing contralateral breast cancer, there is conflicting evidence on whether or not it reduces breast cancer mortality or overall death. The increase in the CPM rate is especially concerning among women with early-stage sporadic breast cancer who have a minimal annual risk for developing contralateral breast cancer, and for many of these women the risk for distant metastatic disease outweighs the risk for contralateral breast cancer. The lack of information about the clinical value of CPM in women with sporadic breast cancer is an important public health problem. This review evaluates current data on the clinical indications for CPM and long-term patient satisfaction and psychosocial outcomes. Gaps in knowledge about the clinical value of CPM, including patient- and physician-related psychosocial factors that influence the decision-making process of CPM among women with sporadic breast cancer, are highlighted.

Abstract B6: Exploratory study of contralateral prophylactic mastectomy in women with breast cancer: Potential role for preoperative genetic counseling

Abstract Background: Breast cancer is the second most common cancer in women and the second leading cause of cancer death in the US. Women with a diagnosis of breast cancer have a risk of developing contralateral breast cancer of up to 11%. Despite lack of clear evidence supporting an increase in the rate of the procedure, rates of contralateral prophylactic mastectomy (CPM) increased dramatically in the past 10 years. Genetic predisposition to breast cancer is an indication for CPM, however it is inconsistently documented. We sought to explore the trends in CPM and variables associated with CPM and genetic counseling within a large healthcare system over a 15-year period. Methods: Retrospective review of CPM documented by the Network Tumor Registry period 1994 — 2008 performed within a four hospital health system in Louisville, KY. We calculated time trends of CPM as a proportion of mastectomy patients each year, and we analyzed clinical, pathologic, and demographic variables among mastectomy patients who underwent CPM compared to those who did not have procedure. Descriptive variables included: age, year of diagnosis, tumor grade, tumor stage, tumor size, tumor histology type, estrogen receptor status, progesterone receptor status, lymph node status, node dissection type previous cancer diagnosis, family history, menopausal status, use of immediate reconstruction, and type of insurance. Our statistical analysis included chi-square (x2), and odds ratios (OR) to determine differences among groups. We evaluated the prevalence and timing of genetic testing among CPM patients by matching CPM patient level data with a prospectively maintained genetic testing comprehensive database. CPM patient level data was matched with corresponding genetic counseling data to determine the trends in usage of genetic counseling. Results: During the study period, 2,496 women with stage I-III invasive breast cancer underwent mastectomy: 2,288 (91.7%) had unilateral mastectomy (UM) alone and 208 (8.7%) underwent UM and CPM. The proportion of all female mastectomy patients who had CPM increased from 0% in 1994 to 27.1% in 2008. Variables significantly associated with CPM were: Age under 65, immediate breast reconstruction, private insurance, family history of cancer and lobular tumor histology. Favorable tumor characteristics such as stage I and tumor size of < 1cm were associated with higher CPM rates, compared to > Stage I disease and tumors > 1cm. There was a statistically significant association with CPM and negative lymph nodes and a history of hormone use. No differences were found in UM vs. UM+CPM by race, ethnicity, tumor grade, ER/PR status or previous history of cancer. Among the 208 CPM patients, 44 (21.2%) received genetic testing and 6 (2.9%) were positive for BRCA mutations. Of the 44 women who received genetic testing, 5 (11.4%) did so prior to surgery. Conclusions: Performance of CPM was associated factors such as small tumor size and age <65 and private insurance. Genetic counseling was rarely used in the risk-assessment of potential CPM patients. Given the increasing frequency of this procedure, this warrants further investigation. Citation Information: Cancer Prev Res 2010;3(12 Suppl):B6.

Contralateral Prophylactic Mastectomy for Unilateral Breast Cancer: An Increasing Trend at a Single Institution

An increasing trend in the use of contralateral prophylactic mastectomy (CPM) for the treatment of unilateral breast cancer has been observed nationally. The purpose of this study was to confirm this trend and to identify differences between the groups that chose unilateral mastectomy alone or with CPM. A prospectively maintained breast cancer database was retrospectively reviewed. Age, histologic grade, stage, education, family history, tumor receptor status, and use of immediate reconstruction were evaluated. Statistical analysis was performed by Fisher's exact test, chi(2) test, and Student's t-test. Between 1998 and 2007, a total of 1639 women who selected UM and 201 who had UM and CPM for unilateral breast cancer were identified. An increasing trend in CPM was observed (6.5% in 1999 vs. 16.1% in 2007). The CPM group was significantly younger (mean age 47.8 vs. 55.1 years, P < .001). No difference in histologic grade was noted between the two groups; however, an increasing trend toward CPM was observed with lower-stage disease. Women with a higher educational level were more likely to have CPM (P < .001). Women with a family history of cancer were also more likely to have CPM (57% vs. 41%, P < .001). Use of reconstruction was similar between the groups (6.0% for CPM vs. 6.7% for UM, P = NS). Our experience parallels the national trend of increasing use of CPM in women diagnosed with unilateral breast cancer. Women who chose to have CPM were younger, more highly educated, and more likely to have a family history of cancer.

Are women satisfied after prophylactic mastectomy

6048 Background: Bilateral prophylactic mastectomy in women with increased breast cancer risk and contralateral prophylactic mastectomy in women with unilateral breast cancer dramatically reduce th...

Are women satisfied after prophylactic mastectomy

6048 Background: Bilateral prophylactic mastectomy in women with increased breast cancer risk and contralateral prophylactic mastectomy in women with unilateral breast cancer dramatically reduce the risk of subsequent breast cancer. However, little is known about long-term satisfaction with the procedure and related quality of life outcomes. Methods: We mailed surveys to 816 women with bilateral or contralateral prophylactic mastectomy done at six health maintenance organizations between 1979 and 1999. The survey included validated measures of satisfaction, quality of life and concern about breast cancer. The first survey mailing included a $5 cash incentive. Nonrespondents received a second survey mailing and a telephone reminder call. Results: We received completed surveys from 661 (81%) women in our sample; 115 women with bilateral and 546 women with contralateral prophylactic mastectomy. For women with bilateral prophylactic mastectomy the mean age at survey was 57 and the mean years since procedure was 12. For women with contralateral prophylactic mastectomy the mean age at survey was 61 and the mean years since procedure was 10. Over 80% of respondents indicated they are very satisfied with their prophylactic mastectomy yet half remain very concerned about their breast cancer risk, with no differences between the two types of prophylactic mastectomy. Among women with bilateral prophylactic mastectomy 65 (61.3%) reported being quite a bit or very much satisfied with their quality of life, versus 391 (76.2%) of women with contralateral prophylactic mastectomy (chi square p=0.03). Younger women were less satisfied with their procedure and quality of life, and had more concern about their breast cancer risk. Results did not vary by time since procedure. Conclusions: Satisfaction and quality of life after bilateral and contralateral prophylactic mastectomy is high but not universal. Surprisingly, many women remain concerned about breast cancer despite undergoing a procedure that dramatically reduces their risk. These results may be useful for women considering prophylactic mastectomy and their clinicians, whose discussions should include clear information on risk reduction. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration National Cancer Institute

Clinical, pathological and genetic features of women at high familial risk of breast cancer undergoing prophylactic mastectomy.

Prophylactic mastectomy (PM) is a risk-management option for women at high familial risk of breast cancer (BC). This study describes the PM experience of women enrolled in a large observational cohort study involving families with a history of hereditary breast cancer. Within 357 multiple-case BC families [119 (33%) BRCA1 or BRCA2 mutation positive], identified via family cancer clinics, 49 cases of PM [21 (43%) BRCA1 or BRCA2 mutation positive] were identified and their clinical, pathological and genetic features reviewed. Families with at least one incidence of PM displayed stronger breast/ovarian cancer histories than did families without PM. Median age at time of PM was 45 years (range 28-58). Ten cases (21%) were bilateral PMs in unaffected women and 39 cases were contralateral PMs in women with prior invasive BC (71%) or ductal carcinoma in situ (DCIS) (8%). Most (88%) underwent total mastectomy. Unnecessary axillary surgery occurred in eight subjects (16%). Malignant histology was found in three PM specimens (6%). Prior to genetic testing, PM was performed in two women who were subsequently shown not to carry the mutation specific to their family. Optimal utilization of genetic testing to guide surgical decision making, appropriate surgical technique and careful pathology examination of PM specimens, are important issues to consider prior to PM in women at high familial risk of BC.

Efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer.

To estimate the efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer. We followed the course of 745 women with a first breast cancer and a family history of breast and/or ovarian cancer who underwent contralateral prophylactic mastectomy at the Mayo Clinic between 1960 and 1993. Family history information and cancer follow-up information were obtained from the medical record, a study-specific questionnaire, and telephone follow-up. Life-tables for contralateral breast cancers, which consider age at first breast cancer, current age, and type of family history, were used to calculate the number of breast cancers expected in our cohort had they not had a prophylactic mastectomy. Of the 745 women in our cohort, 388 were premenopausal (age < 50 years) and 357 were post- menopausal. Eight women developed a contralateral breast cancer. Six events were observed among the premenopausal women, compared with 106.2 predicted, resulting in a risk reduction of 94.4% (95% confidence interval [CI], 87.7% to 97.9%). For the 357 postmenopausal women, 50.3 contralateral breast cancers were predicted, whereas only two were observed, representing a 96.0% risk reduction (95% CI, 85.6% to 99.5%). The incidence of contralateral breast cancer seems to be reduced significantly after contralateral prophylactic mastectomy in women with a personal and family history of breast cancer.