METHODS FOR QUANTIFYING BREAST CANCER-RELATED LYMPHEDEMA IN PATIENTS UNDERGOING A CONTRALATERAL PROPHYLACTIC MASTECTOMY

Patients treated for breast cancer are at risk of developing breast cancer-related lymphedema (BCRL). A significant proportion of patients treated for breast cancer are opting to undergo a contralateral prophylactic mastectomy (CPM). Currently, it remains unclear as to whether the relative volume change (RVC) equation may be used as an alternative to the weight adjusted change (WAC) equation to quantify BCRL in patients who undergo CPM. In order to simplify BCRL screening, our cohort of patients who underwent a CPM (n=310) was matched by BMI to a subset of patients who underwent unilateral breast surgery (n=310). Arm volume measurements were obtained via an optoelectronic perometer preoperatively, postoperatively, and in the follow-up setting every 6-12 months. The correlation of ipsilateral RVC and WAC values for those who underwent bilateral surgery was calculated (r=0.60). Contralateral WAC values for patients in both cohorts were compared, and there was no significant difference between the two distributions in variance (p=0.446). The RVC equation shows potential to be used to quantify ipsilateral postoperative arm volume changes for patients who undergo a CPM. However, a larger trial in which RVC and WAC values are prospectively assessed is needed.

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Impact of bilateral mastectomy with or without immediate reconstruction on time to subsequent therapy in breast cancer in a community oncology clinic.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18154 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18154-e18154

Author(s):

Rajshekhar Chakraborty ◽

Ronald Regal ◽

Brian Johnson ◽

Jennifer Benedict ◽

Bret Edward Buckley Friday

Keyword(s):

Breast Cancer ◽

Prophylactic Mastectomy ◽

Contralateral Prophylactic Mastectomy ◽

Bilateral Mastectomy ◽

Cancer Center ◽

Immediate Reconstruction ◽

Community Oncology ◽

Increased Risk ◽

Significant Difference ◽

Definitive Surgery

e18154 Background: Due to an increase in the elective decision to pursue contralateral prophylactic mastectomy (CPM), the incidence of bilateral mastectomy (BM) with/without postmastectomy reconstruction (R) [BM+/-R] has increased in the last decade. While prior studies at academic centers have investigated concerns regarding its impact on subsequent cancer therapy, we hypothesized that BM+/-R is associated with a delay in initiation of adjuvant therapy (AT) in a community oncology clinic. Methods: This study involved chart review of all patients who underwent mastectomy as definitive surgery for stage I-III breast cancer between 2007 and 2012 and were subsequently followed at Essentia Health Cancer Center. The primary endpoint of the study was the proportion of patients receiving subsequent AT within 6 weeks of surgery (TST6) when compared between different surgical groups. Results: A total of 478 patients were included in the study, with a median age of 63 years. Patients were divided into 4 groups, BM-R (n = 133), BM+R (n = 73), unilateral mastectomy (UM) –R (n = 244) and UM+R (n = 28). Significant demographic differences were identified between the groups including age ( p< 0.001), medical comorbidities ( p< 0.001), and BMI ( p< 0.001). The incidence of any major post-operative complication (including flap/implant failure, infection and wound necrosis/dehiscence) or additional surgeries within 6 weeks of surgery was higher in patients undergoing reconstruction, [BM+R (19%) and UM+R (18%)] compared to those who did not [BM-R (6%) and UM-R (4%)] ( p< 0.001). Patients having major complications or needing additional surgeries within 6 weeks had a lower adjusted likelihood of achieving TST6 compared to those who did not (OR = 0.35; p= 0.009). However, there was no significant difference in TST6 between the surgical groups ( p= 0.31). Conclusions: Immediate post-mastectomy reconstruction is associated with a significantly increased risk of postoperative complications or need for additional surgeries within 6 weeks. In an appropriately selected patient population, CPM and reconstruction do not significantly delay subsequent AT in a community oncology clinic.

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

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.19.3938 ◽

2001 ◽

Vol 19 (19) ◽

pp. 3938-3943 ◽

Cited By ~ 203

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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Contralateral Prophylactic Mastectomy Improves Survival Only Marginally in Patients with Unilateral Triple-Negative Breast Cancer: A Cohort Study Based on SEER Database

10.21203/rs.3.rs-900438/v1 ◽

2021 ◽

Author(s):

Pengcheng Yang ◽

Yuxin Chu ◽

Qian Li ◽

Tianyu Lei ◽

Jia Song ◽

...

Keyword(s):

Breast Cancer ◽

Triple Negative Breast Cancer ◽

Triple Negative ◽

Prophylactic Mastectomy ◽

Radical Mastectomy ◽

Contralateral Prophylactic Mastectomy ◽

Seer Database ◽

Total Mastectomy ◽

Kaplan Meier ◽

Significant Difference

Abstract Background: The effect of contralateral prophylactic mastectomy (CPM) on the survival rate of triple-negative breast cancer (TNBC) patients is still controversial. The purpose of this study was to confirm whether unilateral TNBC patients benefit from CPM.Methods: 10006 patients with unilateral TNBC in the Surveillance, Epidemiology and End Results (SEER) database were enrolled in this study, propensity score matching (PSM) was applied to balance patient assignments. After PSM,3039 pairs of patients were divided into a CPM group and no-CPM group, respectively. All the patients have undergone total mastectomy or radical mastectomy. Cox proportional hazards regression models were used to evaluate overall survival (OS) and breast cancer-specific survival (BCSS) of the two groups. Subgroup analysis was introduced to exclude the effect of confounding factors. To identify potential variables for prognosis, Kaplan–Meier survival analysis and Cox regression analysis were used and were presented by Kaplan–Meier curve and forest plot separately.Results: With a median follow‐up time of 34.5months (IQR 1–83 months), the estimated 5-year BCSS rates for patients in the CPM group and the no-CPM group were 81.96% and 78.71%, the 5-year OS rates were 80.10% and 75.05%, respectively. CPM improved the BCSS (hazard ratio [HR]= 0.79; 95% confidence interval [CI]=0.69-0.90, p=0.001) and OS (HR= 0.74; 95% CI=0.66-0.84, p<0.001) of unilateral TNBC patients. Univariate subgroup analyses revealed that there was no significant difference in survival time for patients in stage N3 who underwent CPM or not (p>0.05).Conclusions: CPM only limitedly improved BCSS and OS in patients with unilateral TNBC undergoing total mastectomy or radical mastectomy and was not recommended for stage N3 patients.

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Impact of Age, Rurality and Distance in Predicting Contralateral Prophylactic Mastectomy for Breast Cancer in a Midwestern state: A Population-Based Study

10.21203/rs.3.rs-54758/v1 ◽

2020 ◽

Author(s):

Ingrid Lizarraga ◽

Amanda R Kahl ◽

Ellie Jacoby ◽

Mary E Charlton ◽

Charles F Lynch ◽

...

Keyword(s):

Breast Cancer ◽

Rural Women ◽

Prophylactic Mastectomy ◽

Contralateral Prophylactic Mastectomy ◽

The United States ◽

Population Based ◽

Travel Distance ◽

Unilateral Breast Cancer

Abstract Background: There is substantial variability in the use of contralateral prophylactic mastectomy (CPM) in women with unilateral breast cancer across the United States. Iowa is one of several rural Midwestern states found to have the highest proportions of CPM nationally in women <45 years of age. We evaluated the role of rurality and travel distance as factors related to these surgical patterns.Methods: Women with unilateral breast cancer (2007-2017) were identified using Iowa Cancer Registry records. Patients and treating hospitals were classified as metro, nonmetro and rural based on Rural-Urban Continuum Codes. Differences in patient, tumor, and treatment characteristics and median travel distances (MTD) were compared. Characteristics associated with CPM were evaluated with multivariate logistic regression.Results: 22,158 women were identified: 57% metro, 26% nonmetro and 18% rural. The overall proportion of CPM in Iowa was consistently higher than in the national Surveillance, Epidemiology, and End Results (SEER18) throughout the interval from 2007-2015. Young rural women had the highest proportion of CPM (<40 years: 52%, 39% and 40% for rural, metro, nonmetro, respectively). Half of all rural women had surgery at metro hospitals; these women had the longest MTD (56 miles). Of all women treated at metro hospitals, rural women had the highest proportion with CPM (17% rural; vs 14% metro/nonmetro, p=0.007). On multivariate analysis, traveling ≥50 miles (ORs 1.48-2.34) or being rural regardless of travel distance was predictive of CPM (OR = 1.36). Other risk factors were young age (<40 years: OR=7.18, 95% CI: 5.89-8.76) and surgery at a metro hospital that offers reconstruction (OR=2.3, 95% CI: 1.70-3.21) and is not NCI-designated (OR=2.19, 95% CI: 1.78-2.69).Conclusion: There is an unexpectedly high proportion of CPM use in young rural women in Iowa. Travel ≥50 miles and rural residence are independently associated with likelihood of CPM. Disparities in access to specialty care may underlie the desire for surgery that is perceived to minimize follow-up visits.

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B-Sure: a randomized pilot trial of an interactive web-based decision support aid versus usual care in average-risk breast cancer patients considering contralateral prophylactic mastectomy

Translational Behavioral Medicine ◽

10.1093/tbm/iby133 ◽

2019 ◽

Vol 10 (2) ◽

pp. 355-363 ◽

Cited By ~ 4

Author(s):

Sharon L Manne ◽

Barbara L Smith ◽

Sara Frederick ◽

Anna Mitarotondo ◽

Deborah A Kashy ◽

...

Keyword(s):

Breast Cancer ◽

Decision Support ◽

Usual Care ◽

Cancer Patients ◽

Prophylactic Mastectomy ◽

Contralateral Prophylactic Mastectomy ◽

Decisional Conflict ◽

Average Risk ◽

Breast Cancer Patients

Abstract The use of contralateral prophylactic mastectomy (CPM) is increasing among breast cancer patients who are at average or “sporadic” risk for contralateral breast cancer. Because CPM provides no survival benefit for these patients, it is not medically recommended for them. Decision support aids may facilitate more informed, higher quality CPM decision. The purpose of this study was to evaluate the feasibility and acceptability of B-Sure, an online decision support aid to facilitate informed decisions regarding CPM, and to compare the impact of B-Sure in increasing CPM knowledge, reducing decisional conflict, and increasing preparedness to make the CPM decision among breast cancer patients at sporadic risk who are considering CPM. Ninety-three patients with unilateral, nonhereditary breast cancer considering CPM completed a baseline survey, were randomized to receive B-Sure or Usual care, and completed a 4-week follow-up survey assessing decisional conflict, preparedness to make the CPM decision, and CPM knowledge as well as self-efficacy, perceived risk, worry, CPM motivations, and the surgical decision. Study participation was high. B-Sure was viewed by almost 80% of the participants and was evaluated positively. At follow-up, patients assigned to B-Sure reported significantly higher clarity regarding the personal values relevant to the CPM decision and higher knowledge about CPM. B-Sure had smaller effects on other aspects of decisional conflict. B-Sure improved CPM knowledge and reduced decisional conflict. Patients considering CPM may benefit from an online decision support aid, but may be sensitive to approaches that they perceive as biased against CPM.

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Contralateral prophylactic mastectomy in breast cancer patients with a family history: A prospective 2-years follow-up study of health related quality of life, sexuality and body image

European Journal of Cancer ◽

10.1016/j.ejca.2012.04.023 ◽

2012 ◽

Vol 48 (17) ◽

pp. 3150-3156 ◽

Cited By ~ 31

Author(s):

Dmytro Unukovych ◽

Kerstin Sandelin ◽

Annelie Liljegren ◽

Brita Arver ◽

Marie Wickman ◽

...

Keyword(s):

Breast Cancer ◽

Prophylactic Mastectomy ◽

Contralateral Prophylactic Mastectomy ◽

Health Related Quality ◽

Breast Cancer Patients ◽

Follow Up Study ◽

Related Quality ◽

Health Related

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Contralateral Prophylactic Mastectomy and Breast Cancer: Clinical and Psychosocial Outcomes

10.25302/10.2018.ce.13046293 ◽

2018 ◽

Author(s):

Abenaa Brewster ◽

Susan Peterson ◽

Scott Cantor ◽

Robert Volk ◽

Yu Shen ◽

...

Keyword(s):

Breast Cancer ◽

Prophylactic Mastectomy ◽

Contralateral Prophylactic Mastectomy ◽

Psychosocial Outcomes

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Electronic Moxibustion for Breast Cancer-Related Lymphedema: A Pilot Clinical Trial

Integrative Cancer Therapies ◽

10.1177/1534735420962854 ◽

2020 ◽

Vol 19 ◽

pp. 153473542096285

Author(s):

Kyungsun Han ◽

Ojin Kwon ◽

Hyo-Ju Park ◽

Ae-Ran Kim ◽

Boram Lee ◽

...

Keyword(s):

Breast Cancer ◽

Clinical Trial ◽

Range Of Motion ◽

Upper Limb ◽

Life Questionnaire ◽

Breast Cancer Patients ◽

Shoulder Range Of Motion ◽

Breast Cancer Related Lymphedema ◽

Shoulder Range

This is a preliminary study to investigate the feasibility of electronic moxibustion in breast cancer patients with upper limb lymphedema. As current treatment options for lymphedema are unsatisfactory and time consuming, there have been attempts to manage symptoms using integrative treatments. Electronic moxibustion was developed to compensate for the shortcomings of conventional moxibustion and is widely used in clinical practice. However, there have been no studies on using electronic moxibustion in breast cancer-related lymphedema. To investigate the feasibility of electronic moxibustion in treating breast cancer-related lymphedema, this study included subjects who completed primary cancer treatment at least 6 months ago and had more than 10 mm difference in arm circumference of upper limbs. All subjects were assigned to the treatment group. Subjects were treated with 16 sessions (30 minutes/session) of electronic moxibustion for 8 weeks followed by 4 weeks of follow-up. For outcome measures, upper limb circumferences, shoulder range of motion, bioimpedance analysis, and quality of life questionnaire were assessed. All 10 subjects completed the study. The effective index showed 38.21% reduction after treatment ( P = .0098) and 29.35% ( P = .0039) after 4 weeks of follow-up compared to the baseline. The reduction of lymphedema was most prominent at 10 cm above the elbow crease, where the mean reduction of circumference difference was 7.5 mm ( P = .0430) and continued to improve after treatment (mean reduction of 8.3 mm, P = .0156). There was significant improvement in shoulder range of motion only in flexion and internal rotation at week 9. There were 7 adverse events, and most were irrelevant to the treatment. Only 1 participant had a mild burn on the acupuncture point. Here, we demonstrate for the first time that electronic moxibustion treatment is a feasible treatment for breast cancer-related lymphedema. Electronic moxibustion may reduce differences in upper limb circumference and improve shoulder range of motion. A future comparative clinical trial is needed to confirm the clinical efficacy of this treatment.

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Breast reconstruction after breast cancer surgery – persistent pain and quality of life 1–8 years after breast reconstruction

Scandinavian Journal of Pain ◽

10.1515/sjpain-2021-0026 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Nina Honkanen ◽

Laura Mustonen ◽

Eija Kalso ◽

Tuomo Meretoja ◽

Hanna Harno

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Breast Reconstruction ◽

Perforator Flap ◽

Persistent Pain ◽

Rectus Abdominis ◽

Preoperative Pain ◽

Significant Difference

Abstract Objectives To assess the long-term outcome of breast reconstructions with special focus on chronic postsurgical pain (CPSP) in a larger cohort of breast cancer survivors. Methods A cross-sectional study on 121 women with mastectomy and breast reconstruction after mean 2 years 4 months follow up. The mean time from breast reconstruction to the follow-up visit was 4 years 2 months. We studied surveys on pain (Brief Pain Inventory, BPI and Douleur Neuropathique 4, DN4), quality of life (RAND-36 health survey), sleep (insomnia severity questionnaire, ISI), mood (Beck’s Depression Index, BDI; Hospital Anxiety and Depression Scale, HADS), and a detailed clinical sensory status. Patients were divided into three groups: abdominal flap (Deep inferior epigastric perforator flap, DIEP; Free transverse rectus abdominis flap, fTRAM, and Pedicled transverse rectus abdominis flap, pTRAM), dorsal flap (Latissimus dorsi flap, LD and Thoracodorsal artery perforator flap, TDAP), and other (Transverse myocutaneous gracilis flap, TMG; implant). Clinically meaningful pain was defined ≥ 4/10 on a numeric rating scale (NRS). We used patients’ pain drawings to localize the pain. We assessed preoperative pain NRS from previous data. Results 106 (87.6%) of the patients did not have clinically meaningful persistent pain. We found no statistically significant difference between different reconstruction types with regards to persistent pain (p=0.40), mood (BDI-II, p=0.41 and HADS A, p=0.54) or sleep (p=0.14), respectively. Preoperative pain prior to breast reconstruction surgery correlated strongly with moderate or severe CPSP. Conclusions Moderate to severe CPSP intensity was present in 14% of patients. We found no significant difference in the prevalence of pain across different reconstruction types. Preoperative pain associated significantly with postoperative persistent pain.

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