Prophylactic mastectomy: The role of risk aversion.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 39-39
Author(s):  
Laura Kruper ◽  
Meghana Bhatt ◽  
Karin London ◽  
Katherine Henderson ◽  
Courtney Vito ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Marital Status ◽  
Prophylactic Mastectomy ◽  
Brca Mutation ◽  
Large Population ◽  
Factors Associated ◽  
Younger Age ◽  
History Of ◽  
Caucasian Patients

39 Background: The rate of women undergoing contralateral prophylactic mastectomy (CPM) has increased significantly over the past decade. Large population studies have examined factors associated with the use of CPM. We studied the factors associated with CPM within our institution. Methods: A 30-question validated survey was mailed to all patients who underwent mastectomy from 1972 to 2011 and are currently receiving treatment or surveillance at our institution. Responses were analyzed to determine the factors predictive of CPM. Multivariate logistic regression methods were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for possible associations between exposures (including age at surgery, marital status, education, race, family history of breast cancer, and BRCA genetic mutation (BRCA mutation) and likelihood of CPM. Results: 368 of 691 surveys were returned. Younger age was statistically significantly associated with increased likelihood of CPM (p-trend < 0.001). Caucasian patients were 4 times as likely to undergo CPM compared to non-Caucasian patients (OR 3.95, 95%CI=1.89-8.23). Patients with a family history of breast cancer were 3 times as likely to undergo CPM as compared with those with no family history (OR 3.38, 95%CI=1.4-8.16). Married patients were also 3 times as likely to undergo CPM compared with unmarried patients (OR 3.00, 95%CI=1.39-6.52). Reporting a BRCA mutation was highly correlated with younger age, positive family history, higher level of education and marital status. Conclusions: When faced with the decision of whether to undergo a CPM, patients must assess both objective future risks and subjective feelings about those risks. These results suggest that the decision to undergo CPM is associated with known risk factors for the development of contralateral cancer such as younger age and positive breast cancer family history. In addition, multiple demographic factors including Caucasian race and married status increased the likelihood of choosing CPM. This may relate to social support as well socioeconomic status. Further exploration into societal factors that impact CPM use is warranted.

Predictors of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ (DCIS) who underwent evaluation for BRCA genetic testing.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1549-1549
Author(s):  
Nisreen Elsayegh ◽  
Angelica M. Gutierrez-Barrera ◽  
Kimberly I. Muse ◽  
Heather Lin ◽  
Diana L. Turco ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Genetic Counseling ◽  
Family History ◽  
Tumor Markers ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Educational Status ◽  
Nuclear Grade ◽  
Factors Associated ◽  
History Of

1549 Background: Patients with DCIS are at increased risk for developing contralateral breast cancer (CBC). Therefore, an increasing number of women with DCIS are electing for contralateral prophylactic mastectomy (CPM). In a previous study involving 2072 women with DCIS, 13.5% chose CPM. In this study, we aimed to evaluate factors associated with CPM in patients with DCIS who underwent genetic counseling for BRCA. Methods: 165 women with pure DCIS, who underwent genetic counseling, were included in the study. Patients’ characteristics were obtained from a prospectively maintained research database at UT M.D. Anderson Cancer Center. Univariate and multivaraite logistic regression analysis were used to determine predictive factors associated with CPM. Patients’ characteristics included age, marital and educational status, tumor markers, nuclear grade, family history with breast (BC) and ovarian cancer (OC), race, Ashkenazi Jewish ancestry, and BRCA genetic test results. Results: Out of 165 patients, 17(10.3%) were found to have a BRCA deleterious mutation. 44(26.7%) underwent CPM. Younger patients (median ≤ 45 yr) were more likely to elect for CPM than older patients (p= 0.0098). Patients who tested positive for a BRCA mutation were more likely to elect for CPM than those who tested negative or were not tested (p= 0.0001). Patients who had a family history of OC (15 (57.7%) were more likely to choose CPM than those who did not (p= 0.0004). These three factors remained significant in the multivariate model (p <0.008). Marital and educational status, tumor markers, nuclear grade, and family history of breast cancer were not significant predictors of CPM. Conclusions: The rate of CPM in patients with DCIS is high. Factors associated with increased likelihood of undergoing CPM include family history of OC, age, and BRCA positivity. Further studies are needed to evaluate patients perception of CBC risk, and if this may play a role in the high number of CPM.

Assessment of breast cancer risk in BRCA carriers with ovarian cancer: Evaluation of data from longitudinal observation.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13062-e13062
Author(s):  
Tamar Safra ◽  
Barliz Waissengrin ◽  
Deanna Gerber ◽  
Rinat Bernstein Molho ◽  
Amnon Amit ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ovarian Cancer ◽  
Family History ◽  
Prophylactic Mastectomy ◽  
Brca Mutation ◽  
Ashkenazi Jews ◽  
Luminal A ◽  
Luminal B ◽  
History Of

e13062 Background: To confirm data from older studies reporting reduced risks of breast cancer (BC) in BRCA mutated (BRCA+) ovarian cancer (OC) patients and to re-evaluate BC surveillance and/or prophylactic mastectomy in OC patients. Methods: Data on 430 BRCA+ mutation carriers diagnosed with OC between 2000 and 2017 in 6 medical centers (one in the USA and five in Israel) were analyzed. Data included demographics, breast surveillance type, family history, BRCA mutation types, timing of BC diagnosis (before or after OC diagnosis) and family history of cancer. Results: Median age at diagnosis of OC was 55.4 years (range, 31.3-90) and median follow-up was 4.6 years. Most patients were BRCA1 (66.6%), and 35.7% had 185delAG. Most patients (68.4%) were Ashkenazi Jews, 27.4% had a family history of BC and 16.5% were diagnosed with BC before OC. Five percent developed BC following OC diagnosis with a median time to BC diagnosis of 68 months (range, 11-210). Of those diagnosed with BC, 50% had triple-negative BC, 40% had luminal B ER+, PR-, Her2-neg and 10% had luminal A -ER+, PR+, her2-neg. There was a non-significant increase in BC after OC, and in BC prior to OC diagnosis; there was no correlation of BC with family history. No definite deaths from BC were recorded. Conclusions: The incidence of BC after OC diagnosis in the BRCA+ population at a median follow-up of 4.6 years is consistent with prior series. Prophylactic bilateral Surveillance measures should be re-evaluated in this population and may only be needed in long-term disease-free survivors and/or subpopulations to be identified. Clinical trial information: 07-146.

Predictors that influence contralateral prophylactic mastectomy election among women with ductal carcinoma in situ who tested negative for a BRCA mutation.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 42-42
Author(s):  
Nisreen Elsayegh ◽  
Heather Y. Lin ◽  
Angelica M. Gutierrez-Barrera ◽  
Jessica Profato ◽  
Jennifer Keating Litton ◽  
...  
Keyword(s):  
Family History ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Prophylactic Mastectomy ◽  
Brca Mutation ◽  
Contralateral Prophylactic Mastectomy ◽  
Factors Associated ◽  
History Of ◽  
Brca Negative

42 Background: 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 previously reported a 27% CPM rate among patients with DCIS who were evaluated for BRCA genetic testing (positive, negative, not tested). In this specific cohort, we further evaluated factors associated with CPM in patients with DCIS who tested negative for a BRCA mutation. Specifically, we aimed to identify differences within BRCA-negative patients who underwent CPM and those who did not. Methods: This retrospective study from a prospective registry included 100 women with DCIS referred for genetic counseling between 2003 and 2011. Patient characteristics included: 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. Results: Of 100 BRCA-negative patients, 31 (31%) underwent CPM. Univariate analysis revealed patients who had a first-degree relative with OC were more likely to elect CPM that those who did not (p = 0.0278). Patients who had a family history of OC (53.3%) were more likely to choose CPM than those with no family history (p = 0.0425). Married patients were more likely to elect CPM than those who were not married (p = 0.0235). In multivariate analysis, married patients were more likely to elect CPM than those who were not married (OR = 4.367; 95% CI, 1.198-15.924; p = 0.0255). Conclusions: The CPM rate among patients with DCIS who tested negative for a BRCA mutation is high. Factors associated with increased rate of CPM among this group include a family history of OC and being married. Further studies are needed to evaluate patients' perceptions of CBC risk and their role in the likelihood of CPM choice.

scholarly journals Factors associated with breast MRI use among women with a family history of breast cancer

2018 ◽  
Vol 24 (5) ◽  
pp. 764-771 ◽  
Author(s):  
Mary C. White ◽  
Ashwini Soman ◽  
Clarice R. Weinberg ◽  
Juan L. Rodriguez ◽  
Susan A. Sabatino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Breast Mri ◽  
Factors Associated ◽  
History Of

Efficacy of Bilateral Prophylactic Mastectomy in Women with a Family History of Breast Cancer

1999 ◽  
Vol 54 (6) ◽  
pp. 381-383
Author(s):  
Lynn C. Hartmann ◽  
Daniel J. Schaid ◽  
John E. Woods ◽  
Thomas P. Crotty ◽  
Jeffrey L. Myers ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Prophylactic Mastectomy ◽  
Bilateral Prophylactic Mastectomy ◽  
History Of

scholarly journals The Importance of a Family History of Breast Cancer in Predicting the Presence of a BRCA Mutation

1999 ◽  
Vol 65 (6) ◽  
pp. 1776-1778 ◽  
Author(s):  
William D. Foulkes ◽  
Jean-Sébastien Brunet ◽  
Ellen Warner ◽  
Pamela J. Goodwin ◽  
Wendy Meschino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Brca Mutation ◽  
History Of

Factors associated with the incompliance with mammogram screening among individuals with a family history of breast cancer or ovarian cancer

2006 ◽  
Vol 101 (3) ◽  
pp. 317-324 ◽  
Author(s):  
Hongyu Wu ◽  
Kangmin Zhu ◽  
Ismail Jatoi ◽  
Mona Shah ◽  
Craig D. Shriver ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ovarian Cancer ◽  
Family History ◽  
Factors Associated ◽  
History Of

scholarly journals Depression, Anxiety and Stress among Obese Patients with Chronic Illnesses: Prevalence and Associated Factors in North East Malaysia

2019 ◽  
Vol 18 (2) ◽  
pp. 252-259
Author(s):  
Raihan Hassan ◽  
Maryam Mohd Zulkifli ◽  
Imran Ahmad ◽  
Siti Suhaila MohdYusoff
Keyword(s):  
Family History ◽  
Outpatient Clinic ◽  
Psychiatric Illness ◽  
Medical Science ◽  
High Body Mass Index ◽  
Medical Illness ◽  
Obese Patients ◽  
Factors Associated ◽  
Younger Age ◽  
History Of

Introduction: Concomitant obesity and chronic medical illness is a significant health problem in Malaysia and worldwide. The comorbid psychological impact in obese patients is associated with a social stigma and low self-esteem. The aim of this study was to determine the prevalence and the factors associated with depression, anxiety and stress in obese patients with chronic medical illnesses attending an outpatient clinic. Methods: This was a cross-sectional study among obese patients with chronic medical illnesses presenting at the Universiti Sains Malaysia Hospital outpatient clinic. A total of 274 patients were involved. The 21-item Depression, Anxiety and Stress Scale questionnaire was used, and the results were evaluated using single and multiple logistic regression analyses. Results: The prevalences of depression, anxiety and stress among the obese patients with chronic medical illnesses were 13.9%, 23.4% and 10.9%, respectively. Younger age [p=0.003, adjusted odds ratio (AOR),1.0; 95%confidence interval (CI),0.91–0.98], unemployed employment(p=0.013, AOR,3.7;95% CI,1.32–10.09) and smoking (p=0.022, AOR,3.2; 95% CI,1.18–8.55) were associated with depression. No formal education (p=0.011, AOR,5.7; 95%CI,1.49–21.89), high body mass index (p=0.029, AOR,1.1;95% CI,1.01–1.13) and family history of psychiatric illness (p=0.018, AOR,5.1; 95% CI,1.33–19.56) were associated with anxiety. Stress was strongly associated with females (p=0.004, AOR,5.0; 95% CI,1.70–15.13) and smoking(p=0.002, AOR,6.5; 95% CI,2.03–20.7). Conclusion: Interestingly, younger age group was associated with depression. Current smokers, no education, family history of psychiatric illness and female sex were significantly associated with anxiety and stress. This notifies new emerging knowledge on factors associated with obese patients that would empower the development of effective preventive strategies for it. Bangladesh Journal of Medical Science Vol.18(2) 2019 p.252-259

Clinical factors that affect breast cancer risk reduction decisions in high risk women tested for the BRCA1/2 genetic mutation

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1013-1013
Author(s):  
A. R. Uyei ◽  
K. R. Broglio ◽  
T. L. Solomon ◽  
K. J. Vogel ◽  
C. I. Amos ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ovarian Cancer ◽  
Family History ◽  
Risk Reduction ◽  
Breast Biopsy ◽  
Prophylactic Mastectomy ◽  
Prophylactic Surgery ◽  
Clinical Factors ◽  
Prophylactic Oophorectomy ◽  
History Of

1013 Background: Women with an increased risk for breast cancer have many risk reduction options including: prophylactic mastectomy, prophylactic oophorectomy, chemoprevention, and screening. Women without breast cancer make such decisions in a purely preventive setting and factors that affect their decisions are unclear. Method: We performed an IRB approved retrospective review of the medical records on women who underwent BRCA testing. We evaluated the women without a history of breast cancer to assess clinical characteristics and their relation to decision making. The risk reduction categories analyzed were: prophylactic mastectomy, prophylactic oophorectomy, tamoxifen, increased surveillance with MRI, and standard screening (clinical breast exam and mammography). Patient characteristics were tabulated by clinical decision group and the chi-square test or Fisher’s exact test was used. Results: From 2001, 627 patients have undergone genetic testing. 202 of these women did not have a history of breast cancer among whom 58 were mutation carriers. Most patients chose standard screening (47%) or increased surveillance (38%). 4% chose tamoxifen, 7% chose prophylactic mastectomy, 3% chose both prophylactic mastectomy and oophorectomy, and 5% chose oophorectomy. The tamoxifen group was too small to do further analysis. Increased surveillance did not show any significant association with any of the clinical factors that we evaluated. The majority of women who chose standard screening had a personal history of ovarian cancer (p<0.0001) and had no family history of ovarian cancer (p=0.02). Prophylactic surgeries were significantly associated with positive BRCA status (p=0.01). Women with a family history of ovarian cancer tended to have prophylactic surgery (p=0.02). Women who had DCIS or a breast biopsy tended to have prophylactic mastectomies (p=0.0001 and p<0.001 respectively). Conclusion: In breast cancer free women, BRCA status, family history of ovarian cancer, DCIS, and breast biopsy were associated with prophylactic surgeries. Having ovarian cancer or no family history of ovarian cancer were associated with standard screening. We are performing a questionnaire study to determine the reasons behind these women’s choices. No significant financial relationships to disclose.

Sign in / Sign up

Export Citation Format

Share Document