Standard psychological consultations and follow up for women at increased risk of hereditary breast cancer considering prophylactic mastectomy

Background There are no published international consensus or guideline documents regarding appropriate medical follow-up for women with hereditary increased risk of breast cancer who opt for prophylactic mastectomy. Moreover, it is not known whether breast magnetic resonance imaging (MRI) performed after a prophylactic mastectomy is a reproducible method for evaluating whether clinically relevant amounts of residual glandular tissue remains. Purpose To evaluate the inter- and intra-observer agreement on detecting residual glandular tissue with MRI. Material and Methods In total, 40 women previously operated with prophylactic mastectomy underwent MRI and two breast radiologists (R1 and R2) independently assessed the presence of residual glandular tissue. Inter- and intra-rater agreements were assessed using Cohen's kappa (k). Results Residual glandular tissue was found in 69 of 248 quadrants (27.8%) and 32 of 62 breasts (51.6%) by R1 and 77 of 248 quadrants (31.1%) and 35 of 62 breasts (56.5%) by R2. The interrater agreement was observed to be moderate (k = 0.554) and the intra-rater agreement was observed to be substantial (k = 0.623). Conclusion In conclusion, the inter-and intra-rater observer agreement in regard to detection of residual glandular tissue was not excellent, which would be desirable for a method considered reproducible enough to be used as a surveillance tool after the surgical procedure in order to ensure that there is no relevant residual glandular tissue remaining warranting further follow-up. More research is needed, as well as establishment of precise protocols, before using the method in risk assessment of remaining glandular tissue and breast cancer risk.

Download Full-text

Intention to Undergo Prophylactic Bilateral Mastectomy in Women at Increased Risk of Developing Hereditary Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2000.18.11.2250 ◽

2000 ◽

Vol 18 (11) ◽

pp. 2250-2257 ◽

Cited By ~ 92

Author(s):

Bettina Meiser ◽

Phyllis Butow ◽

Michael Friedlander ◽

Vivienne Schnieden ◽

Michael Gattas ◽

...

Keyword(s):

Breast Cancer ◽

High Risk ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Hereditary Breast Cancer ◽

Risk Perceptions ◽

Prophylactic Mastectomy ◽

Bilateral Mastectomy ◽

Increased Risk ◽

Prophylactic Bilateral Mastectomy

PURPOSE: To assess intention to undergo prophylactic bilateral mastectomy and psychologic determinants in unaffected women at increased risk of developing hereditary breast cancer. PATIENTS AND METHODS: Three hundred thirty-three women who were awaiting their initial appointments for risk assessment, advice about surveillance, and prophylactic options at one of 14 familial cancer clinics participated in a cross-sectional, questionnaire-based survey. RESULTS: Nineteen percent of women would consider and 47% would not consider a prophylactic mastectomy, should genetic testing identify a mutation in a breast cancer–predisposing gene, whereas 34% were unsure and 1% had already undergone a prophylactic mastectomy. In a bivariate analysis, women at a moderately increased risk of developing breast cancer had the highest proportion of subjects reporting that they would consider a prophylactic mastectomy (25%), compared with women at high risk (16%) (χ2 = 7.79; P = .051). In multivariate analyses, consideration of prophylactic mastectomy strongly correlated with high levels of breast cancer anxiety (odds ratio [OR] = 17.4; 95% confidence interval [CI], 4.35 to 69.71; P = .0001) and overestimation of one’s breast cancer risk (OR = 3.01; 95% CI, 1.43 to 6.32; P = .0036), whereas there was no association with objective breast cancer risk (P = .60). CONCLUSION: A significant proportion of women at increased risk of developing hereditary breast cancer would consider prophylactic mastectomy. Although prophylactic mastectomy may be appropriate in women at high risk of developing breast cancer, it is perhaps less so in those who have a moderately increased risk. Such moderate-risk women are likely to benefit from interventions aimed at reducing breast cancer anxiety and correcting exaggerated breast cancer risk perceptions.

Download Full-text

Risk of primary gastrointestinal cancers following incident non-metastatic breast cancer: a Danish population-based cohort study

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2020-000413 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000413

Author(s):

Kasper Adelborg ◽

Dóra Körmendiné Farkas ◽

Jens Sundbøll ◽

Lidia Schapira ◽

Suzanne Tamang ◽

...

Keyword(s):

Breast Cancer ◽

Colon Cancer ◽

Cohort Study ◽

Metastatic Breast Cancer ◽

Stomach Cancer ◽

Metastatic Breast ◽

Population Based ◽

Gastrointestinal Cancers ◽

Increased Risk

ObjectiveWe examined the risk of primary gastrointestinal cancers in women with breast cancer and compared this risk with that of the general population.DesignUsing population-based Danish registries, we conducted a cohort study of women with incident non-metastatic breast cancer (1990–2017). We computed cumulative cancer incidences and standardised incidence ratios (SIRs).ResultsAmong 84 972 patients with breast cancer, we observed 2340 gastrointestinal cancers. After 20 years of follow-up, the cumulative incidence of gastrointestinal cancers was 4%, driven mainly by colon cancers. Only risk of stomach cancer was continually increased beyond 1 year following breast cancer. The SIR for colon cancer was neutral during 2–5 years of follow-up and approximately 1.2-fold increased thereafter. For cancer of the oesophagus, the SIR was increased only during 6–10 years. There was a weak association with pancreas cancer beyond 10 years. Between 1990–2006 and 2007–2017, the 1–10 years SIR estimate decreased and reached unity for upper gastrointestinal cancers (oesophagus, stomach, and small intestine). For lower gastrointestinal cancers (colon, rectum, and anal canal), the SIR estimate was increased only after 2007. No temporal effects were observed for the remaining gastrointestinal cancers. Treatment effects were negligible.ConclusionBreast cancer survivors were at increased risk of oesophagus and stomach cancer, but only before 2007. The risk of colon cancer was increased, but only after 2007.

Download Full-text

Beyond BRCA: Review of Hereditary Syndromes Predisposing to Breast Cancer

Journal of Breast Imaging ◽

10.1093/jbi/wbz014 ◽

2019 ◽

Vol 1 (2) ◽

pp. 84-91

Author(s):

Jonathan V Nguyen ◽

Martha H Thomas

Keyword(s):

Breast Cancer ◽

At Risk ◽

Cancer Screening ◽

Risk Reduction ◽

Breast Cancer Screening ◽

Hereditary Breast Cancer ◽

Cancer Genes ◽

Her Family ◽

Increased Risk ◽

Screening Mammograms

Abstract The majority of our hereditary breast cancer genes incur not only an increased risk for breast cancer but for other malignancies as well. Knowing whether an individual carries a pathogenic variant in a hereditary breast cancer gene can affect not only screening for the patient but for his or her family members as well. Identifying and appropriately testing individuals via multigene panels allows for risk reduction and early surveillance in at-risk individuals. Radiologists can serve as first-line identifiers of women who are at risk of having an inherited predisposition to breast cancer because they are interacting with all women receiving routine screening mammograms, and collecting family history suggestive of the presence of a mutation. We outline here the 11 genes associated with high breast cancer risk discussed in the National Comprehensive Cancer Network Genetic/Familial High-Risk: Breast and Ovarian (version 3.2019) as having additional breast cancer screening recommendations outside of annual mammography to serve as a guide for breast cancer screening and risk reduction, as well as recommendations for surveillance of nonbreast cancers.

Download Full-text

Association of Cardiovascular Risk Factors With Cardiac Events and Survival Outcomes Among Patients With Breast Cancer Enrolled in SWOG Clinical Trials

Journal of Clinical Oncology ◽

10.1200/jco.2017.77.4414 ◽

2018 ◽

Vol 36 (26) ◽

pp. 2710-2717 ◽

Cited By ~ 21

Author(s):

Dawn L. Hershman ◽

Cathee Till ◽

Sherry Shen ◽

Jason D. Wright ◽

Scott D. Ramsey ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Cardiovascular Disease ◽

Overall Survival ◽

Clinical Trials ◽

Survival Outcomes ◽

Cardiac Events ◽

Free Survival ◽

Increased Risk

Background Cardiovascular disease is the primary cause of death among patients with breast cancer. However, the association of cardiovascular-disease risk factors (CVD-RFs) with long-term survival and cardiac events is not well studied. Methods We examined SWOG (formerly the Southwest Oncology Group) breast cancer trials from 1999 to 2011. We identified baseline diabetes, hypertension, hypercholesterolemia, and coronary artery disease by linking trial records to Medicare claims. The primary outcome was overall survival. Patients with both baseline and follow-up claims were examined for cardiac events. Cox regression was used to assess the association between CVD-RFs and outcomes. Results We identified 1,460 participants older than 66 years of age from five trials; 842 were eligible for survival outcomes analysis. At baseline, median age was 70 years, and median follow-up was 6 years. Hypertension (73%) and hypercholesterolemia (57%) were the most prevalent conditions; 87% of patients had one or more CVD-RF. There was no association between any of the individual CVD-RFs and overall survival except for hypercholesterolemia, which was associated with improved overall survival (hazard ratio [HR], 0.73; 95% CI, 0.57 to 0.93; P = .01). With each additional CVD-RF, there was an increased risk of death (HR, 1.23; 95% CI, 1.08 to 1.40; P = .002), worse progression-free survival (HR, 1.12; 95% CI, 1.00 to 1.25; P = .05), and marginally worse cancer-free survival (HR, 1.15; 95% CI, 0.99 to 1.34; P = .07). The relationship between baseline CVD-RFs and cardiac events was analyzed in 736 patients. A strong linear association between the number of CVD-RFs and cardiac event was observed (HR per CVD-RF, 1.41; 95% CI, 1.17 to 1.69; P < .001). Conclusion Among participants in clinical trials, each additional baseline CVD-RF was associated with an increased risk of cardiac events and death. Efforts to improve control of modifiable CVD-RFs are needed, especially among those with multiple risk factors.

Download Full-text

Management of Women at Increased Risk for Hereditary Breast Cancer

Breast Disease ◽

10.3233/bd-2007-27104 ◽

2007 ◽

Vol 27 (1) ◽

pp. 51-67 ◽

Cited By ~ 12

Author(s):

Karen Lisa Smith ◽

Claudine Isaacs

Keyword(s):

Breast Cancer ◽

Hereditary Breast Cancer ◽

Increased Risk

Download Full-text

Hereditary Breast Cancer: Prophylactic Mastectomy, Breast Conservation, and Rates of Cancer

Oncoplastic and Reconstructive Breast Surgery ◽

10.1007/978-3-319-62927-8_4 ◽

2019 ◽

pp. 33-42

Author(s):

Siun M. Walsh ◽

Mark E. Robson ◽

Virgilio S. Sacchini

Keyword(s):

Breast Cancer ◽

Hereditary Breast Cancer ◽

Prophylactic Mastectomy ◽

Breast Conservation

Download Full-text

Role of Hormones in Cancer Prevention

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2014.34.34 ◽

2014 ◽

pp. 34-40 ◽

Cited By ~ 7

Author(s):

Victor G. Vogel

Keyword(s):

Breast Cancer ◽

Aromatase Inhibitor ◽

Postmenopausal Women ◽

Invasive Breast Cancer ◽

White Women ◽

Risk Index ◽

Breast Cancer Incidence ◽

The United States ◽

Increased Risk

Risk for breast cancer can be easily and rapidly assessed using validated, quantitative models. Multiple randomized studies show that the selective estrogen response modifiers (SERMs) tamoxifen and raloxifene can safely reduce the risk of invasive breast cancer in both pre- and postmenopausal women. Treatment resulted in a 38% reduction in breast cancer incidence, and 42 women would need to be treated to prevent one breast cancer event in the first 10 years of follow-up. Reduction was larger in the first 5 years of follow-up than in years 5 to 10, but no studies treated patients for longer than 5 years. Thromboembolic events were significantly increased with all SERMs, whereas vertebral fractures were reduced. Tamoxifen provides net benefit to all premenopausal women who are at increased risk, whereas raloxifene reduces risk nearly as much in postmenopausal women and offers increased safety. Both tamoxifen and raloxifene reduce the incidence of in situ cancers. Lasofoxifene reduced the risk of breast cancer by 79% in postmenopausal women with osteoporosis. The MAP3 trial showed a 65% reduction in the annual incidence of invasive breast cancer in postmenopausal women who were at moderately increased risk for breast cancer who took the aromatase inhibitor exemestane. The IBIS-II trial showed a 53% reduction in the risk of invasive breast cancer in postmenopausal women aged 40 to 70 who took the aromatase inhibitor anastrozole. Of the 50 million white women in the United States aged 35 to 79, 2.4 million would have a positive benefit/risk index for chemoprevention.

Download Full-text