Contralateral Risk-reducing Mastectomy Research Articles

Associations between Reoperations and Psychological Factors after Contralateral Risk-Reducing Mastectomy: A Two-Year Follow-Up Study.

Introduction. The aim of the study was to investigate associations between reoperations after contralateral risk-reducing mastectomies (CRRM) and emotional problems, body image, sexuality, and health related quality of life (HRQoL) in women with breast cancer and hereditary high risk. Patients and Methods. Patients scheduled for CRRM with breast reconstruction between 1998 and 2010 completed questionnaires, comprised of SF-36, the Hospital Anxiety and Depression Scale, the Body Image Scale, and the Sexual Activity Questionnaire, preoperatively and two years after CRRM. Data on reoperations was collected from medical charts. Results. A total of 80 women participated, with a response rate of 61 (76%) preoperatively and 57 (71%) at the two-year follow-up. At the two-year assessment, 44 (55%) patients had undergone ≥1 reoperation (reoperation group), whereas 36 (45%) had not (no reoperation group). No statistically significant differences between the groups were found for HRQoL, sexuality, anxiety, or depression. A higher proportion of patients in the “reoperation group” reported being dissatisfied with their bodies (81% versus 48%, p = 0.01). Conclusion. The results suggest associations between reoperation following CRRM with breast reconstruction and body image problems. Special attention should be paid to body image problems among women who are subject to reoperations after CRRM.

Adjuvant radiotherapy for primary breast cancer in BRCA1 and BRCA2 mutation carriers and risk of contralateral breast cancer with special attention to patients irradiated at younger age.

The purpose of this study was to estimate the influence of adjuvant radiotherapy for primary breast cancer (BC) on the risk of contralateral BC (CBC) in BRCA1 or BRCA2(BRCA1/2) mutation carriers, with special attention to patients irradiated at age younger than 40 years. Additionally, tendencies in locoregional treatments and rates of contralateral risk-reducing mastectomy over time were explored. In this retrospective cohort study, 691 BRCA1/2-associated BC patients treated between 1980 and 2013 were followed from diagnosis until CBC or censoring event including ipsilateral BC recurrence, distant metastasis, contralateral risk-reducing mastectomy, other invasive cancer diagnosis, death, or loss to follow up. Hazard ratios (HR) for CBC associated with radiotherapy were estimated using Cox regression. Median follow-up time was 8.6 years [range 0.3–34.3 years]. No association between radiotherapy for primary BC and risk of CBC was found, neither in the total population (HR 0.82, 95 % CI 0.45–1.49) nor in the subgroup of patients younger than 40 years at primary diagnosis (HR 1.36, 95 % CI 0.60–3.09). During follow-up, the number of patients at risk decreased substantially since a large proportion of patients were censored after contralateral risk-reducing mastectomy or BC recurrence. Over the years, increasing preference for mastectomy without radiotherapy compared to breast-conserving surgery with radiotherapy was found ranging from less than 30 % in 1995 to almost 50 % after 2010. The rate of contralateral risk-reducing mastectomy increased over the years from less than 40 % in 1995 to more than 60 % after 2010. In this cohort of BRCA1/2-associated BC patients, no association between radiotherapy for primary BC and risk of CBC was observed in the total group, nor in the patients irradiated before the age of 40 years. The number of patients at risk after 10 and 15 years of follow-up, however, was too small to definitively exclude harmful effects of adjuvant radiotherapy.

The Manchester guidelines for contralateral risk-reducing mastectomy.

BackgroundRates of contralateral risk-reducing mastectomy (CRRM) are rising, despite a decreasing global incidence of contralateral breast cancer. Reasons for requesting this procedure are complex, and we have previously shown a variable practice amongst breast and plastic surgeons in England. We propose a protocol, based on a published systematic review, a national UK survey and the Manchester experience of CRRM.MethodsWe reviewed the literature for risk factors for contralateral breast cancer and have devised a 5-step process that includes history taking, calculating contralateral breast cancer risk, cooling off period/counselling, multi-disciplinary assessment and consent. Members of the multi-disciplinary team included the breast surgeon, plastic surgeon and geneticist, who formulated guidelines.ResultsA simple formula to calculate the life-time risk of contralateral breast cancer has been devised. This allows stratification of breast cancer patients into different risk-groups: low, above average, moderate and high risk. Recommendations vary according to different risk groups.ConclusionThese guidelines are a useful tool for clinicians counselling women requesting CRRM. Risk assessment is mandatory in this group of patients, and our formula allows evidence-based recommendations to be made.

Risk of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers: a 30-year semi-prospective analysis.

BRCA1 and BRCA2 mutation carriers have an increased risk of contralateral breast cancer after primary breast cancer. Risk reduction strategies are discussed after assessment of risk factors for developing contralateral breast cancer. We assessed potential risk factors that could be of use in clinical practice, including the novel use of single nucleotide polymorphisms (SNP) testing. 506 BRCA1 and 505 BRCA2 mutation carriers with a diagnosis of breast cancer were observed for up to 30 years. The risk of a contralateral breast cancer is approximately 2-3% per year, remaining constant for at least 20 years. This was similar in both BRCA1 and BRCA2 carriers. Initial breast cancer before age 40-years was a significant risk factor, which was more pronounced in BRCA1 patients. The effect of risk-reducing oophorectomy on contralateral breast cancer risk may be overestimated because of bias. No significant association was found between overall breast cancer risk SNP score and contralateral breast cancer development. Young mutation carriers, particularly those with BRCA1 mutations, who develop breast cancer have a significantly higher risk of developing contralateral breast cancer, remaining constant for over 20 years. Contralateral risk-reducing mastectomy should be considered in this group, in particular as there is a survival benefit. Caution is advised when counselling women considering risk-reducing oophorectomy as, after accounting for statistical bias, the associated risk reduction was found to be non-significant, and potentially smaller than has been previously reported. SNP testing did not add any further discriminatory information when assessing contralateral breast cancer risk.

Abstract P4-12-09: Low-level constitutional mosaicism of a de novo BRCA1 gene mutation

Abstract Background: Germline mutations in the BRCA1 and BRCA2 genes detected in some high-risk breast/ovarian families are used to estimate cancer risk, plan cancer early detection schemes, and make decisions about risk reducing surgeries. The gold standard for detecting BRCA sequence changes has long been Sanger sequencing, but recently next-generation sequencing (NGS) technologies have emerged as an accurate and efficient alternative, with improved sensitivity for detection of mosaic events. Here we report the detection of low-level constitutional germline mosaicism (∼5%) for a de novo pathogenic BRCA1 mutation detected using deep sequencing of three different non-cancerous tissues; and a corresponding high-level detection (∼50%) in cancerous breast tissue. This is the first reported case of multiple tissue constitutional mosaicism in BRCA1 at this level of detection. Patient and Methods: The patient is a woman of mixed Jewish Ashkenazi - Bulgarian heritage, diagnosed with a large (8x10 cm), triple negative, high-grade invasive breast cancer in the right breast at age 43 years. Her cancer family history includes a daughter with acute lymphatic leukemia at age 18 months, a brother with a Central Nervous System (CNS) tumor at age 45 years, a father with a malignant CNS tumor at age 58 years, a maternal grandfather with a malignant tumor in his 70's, and two of this maternal grandfather's sisters who were diagnosed with breast cancer. The patient underwent neoadjuvant chemotherapy followed by bilateral mastectomy (therapeutic mastectomy for the right breast and a contralateral risk-reducing mastectomy). The patient underwent germline testing using NGS, sequencing of 29 hereditary cancer genes in DNA extracted from blood using Invitae’s Hereditary Cancer Panel. This testing was followed up with additional NGS testing of buccal and contralateral healthy breast tissue. The patient also underwent somatic mutation testing on her breast tumor. Results: NGS of DNA extracted from blood identified a pathogenic BRCA1 mutation, c.1953dupG (p.Lys652GlufX21), in 5% of reads (X450 coverage). No other pathogenic mutations were detected in other genotyped cancer susceptibility genes. Analysis of buccal tissue and normal breast tissue removed at initial surgery also identified this mutation in ∼5% of reads, and confirm that this individual is a constitutional mosaic for this mutation. Genetic analyses were subsequently performed on the breast cancer tissue using Genome Health platform (Foundation One) and the same mutation, c.1943dupG was detected in 47% of molecules. Sanger sequencing of BRCA1 and BRCA2 in DNA extracted from peripheral blood had not detected this mutation. Analysis of the maternal DNA did not reveal this mutation, and analysis of the father was not possible. Conclusion: This is the first reported case of a de novo constitutional mosaicism in BRCA1 at this level of detection and confirmed across multiple tissue types, and highlights the need to perform deep sequencing in individuals clinically suspected of having cancer predisposition, prior to considering risk-reducing surgery. Citation Format: Eitan Friedman, Noa Efrat, Lior Soussan-Gutman, Addie Dvir, Yulia Kaplan, Tali Ekstein, Keith Nykamp, Martin Powers, Marina Rabideau, Scott Topper. Low-level constitutional mosaicism of a de novo BRCA1 gene mutation [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-12-09.

Timing of risk reducing mastectomy in breast cancer patients carrying a BRCA1/2 mutation: retrospective data from the Dutch HEBON study.

It is expected that rapid genetic counseling and testing (RGCT) will lead to increasing numbers of breast cancer (BC) patients knowing their BRCA1/2 carrier status before primary surgery. Considering the potential impact of knowing one’s status on uptake and timing of risk-reducing contralateral mastectomy (RRCM), we aimed to evaluate trends over time in RRCM, and differences between carriers identified either before (predictively) or after (diagnostically) diagnosis. We collected data from female BRCA1/2 mutation carriers diagnosed with BC between 1995 and 2009 from four Dutch university hospitals. We compared the timing of genetic testing and RRCM in relation to diagnosis in 1995–2000 versus 2001–2009 for all patients, and predictively and diagnostically tested patients separately. Of 287 patients, 219 (76 %) had a diagnostic BRCA1/2 test. In this cohort, the median time from diagnosis to DNA testing decreased from 28 months for those diagnosed between 1995 and 2000 to 14 months for those diagnosed between 2001 and 2009 (p < 0.001). Similarly, over time women in this cohort underwent RRCM sooner after diagnosis (median of 77 vs. 27 months, p = 0.05). Predictively tested women who subsequently developed BC underwent an immediate RRCM significantly more often than women who had a diagnostic test (21/61, 34 %, vs. 13/170, 7.6 %, p < 0.001). Knowledge of carrying a BRCA1/2 mutation when diagnosed with BC influenced decisions concerning primary surgery. Additionally, in more recent years, women who had not undergone predictive testing were more likely to undergo diagnostic DNA testing and RRCM sooner after diagnosis. This suggests the need for RGCT to guide treatment decisions.Electronic supplementary materialThe online version of this article (doi:10.1007/s10689-015-9788-x) contains supplementary material, which is available to authorized users.

Clinical management of women at high risk of breast cancer.

This article reviews the evidence that underpins breast cancer screening and prevention strategies for women at high risk of the disease, with a particular focus on evidence published in the last 18 months. The review is timely because the US National Comprehensive Cancer Network, the UK National Institute for Health and Care Excellence and the American Society of Clinical Oncology have recently updated relevant guidelines that inform practice. In the recently published literature, there have been several important findings. A meta-analysis of randomized trials of selective oestrogen receptor modulators (SERMs), along with the first results from the International Breast Cancer Intervention Study II trial, further support the use of SERMs and aromatase inhibitors in the primary prevention of breast cancer. A large observational study has provided evidence that the SERM tamoxifen may be efficacious for breast cancer prevention in women who carry mutations in the breast cancer predisposition genes, BRCA1 and BRCA2. Several observational studies have suggested that contralateral risk-reducing mastectomy, following a diagnosis of breast cancer, may reduce mortality. Evidence regarding the optimal management of women at high risk of breast cancer continues to evolve and needs to be rapidly implemented into clinical practice.

Contralateral risk-reducing mastectomy: review of risk factors and risk-reducing strategies.

Rates of contralateral risk-reducing mastectomy have increased substantially over the last decade. Surgical oncologists are often in the frontline, dealing with requests for this procedure. This paper reviews the current evidence base regarding contralateral breast cancer, assesses the various risk-reducing strategies, and evaluates the cost-effectiveness of contralateral risk-reducing mastectomy.

Improved overall survival after contralateral risk-reducing mastectomy in BRCA1/2 mutation carriers with a history of unilateral breast cancer: a prospective analysis.

Data on survival of BRCA1/2-associated primary breast cancer (PBC) patients who opt for subsequent contralateral risk-reducing mastectomy (CRRM) are scarce and inconsistent. We examined the efficacy of CRRM on overall survival in mutation carriers with a history of PBC. From a Dutch multicentre cohort, we selected 583 BRCA-associated PBC patients, being diagnosed between 1980 and 2011. Over time, 242 patients (42%) underwent CRRM and 341 patients (58%) remained under surveillance. Survival analyses were performed using Cox models, with CRRM as a time-dependent covariate. The median follow-up after PBC diagnosis was 11.4 years. In the CRRM group, four patients developed contralateral breast cancer (2%), against 64 patients (19%) in the surveillance group (p < 0.001). The mortality was lower in the CRRM group than in the surveillance group (9.6 and 21.6 per 1000 person-years of observation, respectively; adjusted hazard ratio 0.49, 95% confidence interval 0.29-0.82). Survival benefit was especially seen in young PBC patients (<40 years), in patients having a PBC with differentiation grade 1/2 and/or no triple-negative phenotype, and in patients not treated with adjuvant chemotherapy. We conclude that CRRM is associated with improved overall survival in BRCA1/2 mutation carriers with a history of PBC. Further research is warranted to develop a model based on age at diagnosis and tumour and treatment characteristics that can predict survival benefit for specific subgroups of patients, aiming at further personalized counselling and improved decision making.

Contralateral risk reducing mastectomy – A national survey of surgeons' practices and perceptions

Introduction: Rates of contralateral risk reducing mastectomy (CRRM) are rising, with a paucity of data to support this practice. Surgeons working as part of the multi-disciplinary team (MDT) counsel women on these requests without the benefit of established guidelines or an agreed protocol.

Contralateral mastectomy improves survival in women with BRCA1/2-associated breast cancer

BRCA1/2 mutation carriers with breast cancer are at high risk of contralateral disease. Such women often elect to have contralateral risk-reducing mastectomy (CRRM) to reduce the likelihood of recurrence. This study considers whether CRRM improves overall survival. 105 female BRCA1/2 mutation carriers with unilateral breast cancer who underwent CRRM were compared to controls (593 mutation carriers and 105 specifically matched) not undergoing CRRM and diagnosed between 1985 and 2010. Survival was assessed by proportional hazards models, and extended to a matched analysis using stratification by risk-reducing bilateral salpingo-oophorectomy (RRBSO), gene, grade and stage. Median time to CRRM was 1.1years after the primary diagnosis (range 0.0-13.3). Median follow-up was 9.7years in the CRRM group and 8.6 in the non-CRRM group. The 10-year overall survival was 89% in women electing for CRRM (n=105) compared to 71% in the non-CRRM group (n=593); p<0.001. The survival advantage remained after matching for oophorectomy, gene, grade and stage: HR 0.37 (0.17-0.80, p=0.008)-CRRM appeared to act independently of RRBSO. CRRM appears to confer a survival advantage. If this finding is confirmed in a larger series it should form part of the counselling procedure at diagnosis of the primary tumour. The indication for CRRM in women who have had RRBSO also requires further research.

Risk, worry and cosmesis in decision-making for contralateral risk-reducing mastectomy: Analysis of 60 consecutive cases in a specialist breast unit

IntroductionAlthough controversial, use of contralateral risk-reducing mastectomy (CRRM) is increasing. It is not clear whether reduction of objective breast cancer risk or other factors determine decisions for CRRM. We aimed to identify factors that influence these decisions by scrutinising how decisions were made in one centre. MethodsWe reviewed a consecutive series of 60 patients considered for CRRM in one centre. Data sources, analysed using qualitative methods, were records of routine psychological assessment, surgeon letters, case-notes and interviews with four surgeons. ResultsPerceptions of objective risk did not generally drive patients' requests or surgeons' decisions. Instead, CRRM appeared to be mainly performed for psychological reasons: to reduce patients' cancer worry and to achieve cosmetic benefits. ConclusionRoutine use of the term ‘risk-reducing’ surgery masks a clinical decision which usually reflects influences other than risk. As CRRM is often carried out for psychological reasons it follows that evidence about its psychosocial outcomes is needed.

Risk, worry and cosmesis in decision-making for contralateral risk-reducing mastectomy: analysis of 60 consecutive cases in a specialist breast unit

Introduction: Although controversial, use of contralateral risk-reducing mastectomy (CRRM) is increasing. It is not clear whether risk-reduction or other factors determine decisions for CRRM. We aimed to identify factors that influence these decisions by scrutinising how decisions were made in one centre.

Contralateral risk-reducing (prophylactic) mastectomy (RRM) in patients (pts) with breast cancer (BC): Experience at Mastologica Lomas Breast Center in Mexico City.

236 Background: Contralateral RRM has increased in frequency due to patient (pt) and/or physician preference. We explore efficacy and satisfaction of procedure at our institution. Methods: A retrospective review of RRM performed from 2002 to 2010. Age, stage, BC subtype, timing of procedure, RRM pathology, reconstruction technique, complications, delay in systemic therapy, satisfaction index, and pt status were compared to pts. who did not undergo RRM. Results: 27 pts with BC had a contralateral RRM. Mean age was 34 (range 24-61). High-risk factors in 11 (40.75%) pts. Histology of BC breasts included 18 (66.66%) invasive ductal, 5 (18.52%) invasive lobular, 4 (14.81) in situ ductal carcinoma, and 1 (3.70%) tubular carcinoma. RRM was a synchronous contralateral procedure in 12 (44.44%) pts. Breast reconstruction technique for RRM: 22 (81.48%) subpectoralis implants, 2 (7.41%) tissue expanders and secondary implants, 1 (3.7%) latissimus dorsi flap with implant. RRM complications: seroma in 8 (29.63%) cases (2 required evacuation of implant), 5 (18.52%) diverse degrees of nipple-areola complex necrosis, total breast necrosis in one pt. These cases were performed earlier in the series, with a decrease in complications in the latter stages of the analysis. Pathology of RRM specimens: one (3.7%) case of ductal in situ BC in a stage IIa pt. and 4 (14.81%) atypical ductal hyperplasia. Surgical time increased a mean of 75 minutes; systemic therapy was delayed in only 2 (7.41%) pts. Recurrence presented in one pt in index breast after stage 0 BC at 13 months (7 mm invasive ductal), in reconstructed breast (3 mm invasive ductal), both treated with a total mastectomy and sentinel node biopsy. All pts are alive. Two have developed systemic metastases (brain, bone). Satisfaction results (medical and pt) were excellent or good in the RRM in 23 (85.19%), regular in 2 (7.41%), and bad in 2. Conclusions: RRM after BC is increasing in frequency, specially in young age pts. Experience at our institution has made it a safe and commonplace procedure, specially in the younger aged pts. with high risk for a contralateral BC. Longer follow-up is needed to determine efficacy.

Contralateral breast cancer risk in patients with familial breast cancer who tested negative for BRCA1 and BRCA2.

1013 Background: A high incidence of contralateral breast cancer has been reported in patients with BRCA1or BRCA2 mutations while the risk in patients with familial non-BRCA-associated breast cancer remains unclear. This study was undertaken to estimate the risk for contralateral breast cancer in patients of BRCA1- and BRCA2-negative high risk families and to determine predictive risk factors. Methods: A retrospective, multicenter, cohort study was performed from 1996 until 2010 and comprised 3,580 women with unilateral breast cancer from 2,793 high-risk families who were tested negative for BRCA1 or BRCA2 mutations. Kaplan-Meier analysis was used to estimate age-dependent contralateral breast cancer risks. Cox regression analysis was applied to assess the impact of age at first breast cancer on contralateral breast cancer risk. Results: The cumulative risk for contralateral breast cancer 25 years after first breast cancer was 19% (95%CI 16% to 22%) for patients from families with non-BRCA-associated breast cancer. This rate is significantly lower compared to BRCA1 and BRCA2 mutation carriers (46% and 36%, respectively). Younger age at first breast cancer was associated with a significantly higher risk of contralateral breast cancer. After 25 years, 29% (95%CI 20% to 37%) of non-carriers who were younger than 40 years of age at first breast cancer developed contralateral breast cancer, compared with only 15% (95%CI 10% to 20%) of those who were older than 50 years. These incidences are similar to patients with sporadic breast cancer. Conclusions: Contralateral breast cancer risk in patients with familial non-BRCA-associated breast cancer is similar to the risk in patients with sporadic breast cancer and depends on age at first breast cancer. Therefore, risk-reducing contralateral mastectomy does not seem to be adequate for non-BRCA1/2 breast cancer patients.

Contralateral risk-reducing mastectomy in young women

Contralateral risk-reducing mastectomy consists in the surgical removal of the contralateral breast to reduce the risk of breast cancer there [1]. Patients with unilateral primary breast cancer have an increased risk of developing a contralateral breast cancer [2]. In a large-scale study, Quan et al. [3] evaluated the incidence, stage and outcomes of women with contralateral synchronous (defined as tumors diagnosed within 12 months of the initial diagnosis) and metachronous (tumors diagnosed beyond 12 months after the initial diagnosis) breast cancer over a 9-year study period. In the 28,787 cases of breast cancer identified, the mean annual incidence of contralateral breast cancer was 0.1%, while the cumulative incidence of contralateral synchronous cancer was 2.1%, and the cumulative incidence of metachronous cancer was 1.2%. Using the Surveillance, Epidemiology and End Results database (SEER), Gao et al. [4] found that the 5-, 10-, 15-, and 20-year actuarial incidence of developing contralateral breast cancer was 3, 6, 9 and 12%, respectively. The average incidence of contralateral breast cancer per year of follow-up per patient was estimated at 0.6%. Based on these, and other retrospective studies, the incidence rate of contralateral breast cancer in breast cancer patients has been estimated to range from approximately 0.5 to 1.8% per year. Benefits of contralateral risk-reducing mastectomy

Breast cancer in young women

Recent evidence suggests that the incidence of local breast tumor recurrences and failures may be substantially lower than previously thought due to the widespread use of systemic adjuvant therapy and loco-regional treatments. Surgery is a fundamental aspect of the management of breast cancer, and the mainstay of loco-regional treatment. In younger women, the choice of surgical approach (radical mastectomy vs lumpectomy) is influenced by tumor size, multicentricity, breast volume, genetic predisposition to the disease, and the patient’s wishes, because breast resections can have a major impact on the patient’s quality of life. Currently, adjuvant radiotherapy is recommended for all women following breast surgery. It significantly reduces the rate of relapse and overall mortality. Contralateral risk-reducing mastectomy is recommended, proposed in women with a current or previous diagnosis of breast cancer, particularly those with known BRCA1/BRCA2 mutations, women in whom surveillance of the contralateral breast is complicated, and/or to improve symmetry in patients undergoing mastectomy followed by breast reconstruction.

Contralateral risk-reducing mastectomy in BRCA1 and BRCA2 mutation carriers and other high-risk women in the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer (kConFab)

Contralateral risk-reducing mastectomy in BRCA1 and BRCA2 mutation carriers and other high-risk women in the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer (kConFab)

Contralateral risk-reducing mastectomy in BRCA1 and BRCA2 mutation carriers and other high-risk women in the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer (kConFab)

The purpose of this study is to determine the prevalence and predictors of contralateral risk-reducing mastectomy (CRRM) in Australasian women at high familial risk of a second primary breast cancer (BC). Participants were women with unilateral BC and a strong family history of the disease, including BRCA1/2 mutation carriers. Data were collected through interview, self-administered questionnaire and review of pathology and surgical reports. Associations between CRRM and potential predictors were assessed using multivariate logistic regression. Of 1,018 women (median follow-up 11.1 years), 154 (15%) underwent CRRM, 43% of these within 12 months of initial BC surgery. More likely to undergo CRRM were women who were younger at BC diagnosis (odds ratio [OR] = 0.94 per year of age, P < 0.001), were diagnosed more recently (OR = 1.16 per calendar year, P < 0.001), underwent mastectomy as initial definitive BC treatment (OR = 5.2, P < 0.001) and underwent risk-reducing salpingo-oophorectomy (OR = 3.4, P < 0.001). BRCA1/2 mutation status, axillary nodal status and receipt of chemotherapy were not independently associated with CRRM uptake. A contralateral BC event (invasive or in situ) occurred in 177 (20.5%) of the 864 women who did not have CRRM, compared with one chest wall event (0.6%) in the 154 women post-CRRM. The contralateral event rate was 15.1 per 1,000 women-years for non-CRRM women and 0.7 per 1,000 women-years for CRRM women; P < 0.0001. Younger women with more recently diagnosed BC treated with mastectomy are more likely to elect CRRM. Neither BRCA1/2 mutation status, nor the competing risk of BC recurrence and death, appears to influence decision making.

Contralateral risk-reducing mastectomy in BRCA1/2 mutation carriers and other high-risk women in the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer (kConFab)

1509 Background: Contralateral risk-reducing mastectomy (CRRM) reduces contralateral breast cancer (BC) risk by up to 97%. Few studies have examined the prevalence and predictors of CRRM in BC patients at high familial risk of a second primary BC. Methods: Participants were women with unilateral BC and a strong family history of the disease, including BRCA1 and BRCA2 mutation carriers. Data were collected by interview, self-administered questionnaire, and review of pathology and surgical reports. Associations between having CRRM and potential predictors were assessed using multivariate logistic regression. Results: Of 1018 study participants (median follow-up 5.5 years), 154 (15%) underwent CRRM. The median time from initial BC to CRRM was 1 year. More likely to undergo CRRM were women who were younger at the time of their BC diagnosis (odds ratio [OR] = 0.94 per year of age, p &lt; 0.001), those diagnosed more recently (OR = 1.16 per calendar year, p &lt; 0.001), those who underwent mastectomy rather than breast conservation as their initial definitive BC treatment (OR = 5.2, p &lt; 0.001) and those who underwent risk-reducing salpingo-oophorectomy (OR = 3.4, p &lt; 0.001). BRCA1/2 mutation status and tumor characteristics were not independently associated with CRRM uptake. A contralateral BC event occurred in 177 (20.5%) of the 864 women who did not have CRRM, compared with one chest wall event (0.6%) in the 154 women post-CRRM. Conclusions: Younger women with more recently diagnosed BC treated with mastectomy were most likely to elect CRRM. BRCA1/2 mutation status and the competing risk of BC recurrence and death did not appear to influence decision making. No significant financial relationships to disclose.