Contralateral breast cancer in high-risk patients: Identification of risk factors to guide recommendations for contralateral prophylactic mastectomy – A 30-year experience

2013 ◽  
Vol 39 (5) ◽  
pp. 520 ◽  
Author(s):  
Narendra Nath Basu ◽  
Mary O'Driscoll ◽  
Munaza Ahmed ◽  
Sarah Ingham ◽  
Anthony Howell ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
High Risk ◽  
Contralateral Breast Cancer ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Contralateral Breast ◽  
High Risk Patients ◽  
Risk Patients

Factors leading to the decision for contralateral prophylactic mastectomy in patients with breast cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 1528-1528
Author(s):  
M. Yi ◽  
K. K. Hunt ◽  
B. K. Arun ◽  
I. Bedrosian ◽  
A. M. Gutierrez Barrera ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Genetic Testing ◽  
Primary Breast Cancer ◽  
Contralateral Breast Cancer ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Contralateral Breast ◽  
Cancer Center ◽  
Tumor Characteristics ◽  
Increased Risk

1528 Background: Women with breast cancer have an increased risk of developing contralateral breast cancer in their lifetime. Thus increasing numbers of women have been electing to undergo contralateral prophylactic mastectomy (CPM) at the time of their initial breast cancer treatment. The objective of this study was to identify factors that determine the decision for CPM in patients at a major cancer center. Methods: 2,544 women with Stage 0-III unilateral primary breast cancer who underwent surgery to the breast at our institution from January 2000 to August 2006 were identified from a prospectively maintained database. Patient and tumor characteristics were evaluated and comparisons were made between patients who did or did not undergo CPM using logistic regression. Results: Of the 2,544 patients, 1254 (49.3%) underwent total mastectomy for their known cancer; 282 (22.5%) of these patients underwent immediate or delayed CPM. Overall, 171 patients (6.7%) had genetic testing; and the use of testing increased in the latter years of the study (3.% in 2000–2002 vs. 8.2% in 2003–2006, p<.0001). 49 of 171 patients had genetic testing prior to surgery. 10 had a deleterious BRCA1/2 mutation, 9 of whom had a CPM (p=.002). 14 patients without a mutation also had a CPM. Multivariate analysis revealed factors associated with use of CPM were: age younger than 50, white race, family history of breast cancer, higher clinical tumor stage, invasive lobular histology, and use of reconstruction (Table). Conclusions: Both patient and tumor characteristics influence selection of CPM. Although the use of genetic testing is increasing, most women elect to undergo CPM without having genetic testing. Evidence-driven models are needed to better inform women of their absolute risk of contralateral breast cancer as well as competing risk from their primary breast cancer in order to empower them in their active-decision-making. [Table: see text] No significant financial relationships to disclose.

Efficacy of Contralateral Prophylactic Mastectomy in Women With a Personal and Family History of Breast Cancer

2001 ◽  
Vol 19 (19) ◽  
pp. 3938-3943 ◽  
Author(s):  
Shannon K. McDonnell ◽  
Daniel J. Schaid ◽  
Jeffrey L. Myers ◽  
Clive S. Grant ◽  
John H. Donohue ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Risk Reduction ◽  
Contralateral Breast Cancer ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Contralateral Breast ◽  
Breast Cancers ◽  
History Of

PURPOSE: To estimate the efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer. PATIENTS AND METHODS: 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. RESULTS: 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%). CONCLUSION: 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.

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