scholarly journals Contralateral Prophylactic Mastectomy in Women with Unilateral Breast Cancer Who Are Genetic Carriers, Have a Strong Family History or Are just Young at Presentation

Cancers ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 140 ◽  
Author(s):  
Victoria Teoh ◽  
Marios-Konstantinos Tasoulis ◽  
Gerald Gui
Keyword(s):  
Breast Cancer ◽  
Contralateral Breast Cancer ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Risk Groups ◽  
Genetic Mutation ◽  
Contralateral Breast ◽  
Strong Family History ◽  
Unilateral Breast Cancer

The uptake of contralateral prophylactic mastectomy is rising with increasing trends that are possibly highest in the USA. Whilst its role is generally accepted in carriers of recognized high-risk predisposition genes such as BRCA1 and BRCA2 when the affected individual is premenopausal, controversy surrounds the benefit in less understood risk-profile clinical scenarios. This comprehensive review explores the current evidence underpinning the role of contralateral prophylactic mastectomy and its impact on contralateral breast cancer risk and survival in three distinct at-risk groups affected by unilateral breast cancer: known genetic carriers, those with strong familial risk but no demonstrable genetic mutation and women who are of young age at presentation. The review supports the role of contralateral prophylactic mastectomy in “high risk” groups where the evidence suggests a reduction in contralateral breast cancer risk. However, this benefit is less evident in women who are just young at presentation or those who have strong family history but no demonstrable genetic mutation. A multidisciplinary and personalized approach to support individuals in a shared-decision making process is recommended.

scholarly journals Predictors of contralateral breast cancer in patients with unilateral breast cancer undergoing contralateral prophylactic mastectomy

Cancer ◽  
2009 ◽  
Vol 115 (5) ◽  
pp. 962-971 ◽  
Author(s):  
Min Yi ◽  
Funda Meric-Bernstam ◽  
Lavinia P. Middleton ◽  
Banu K. Arun ◽  
Isabelle Bedrosian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Contralateral Breast Cancer ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Contralateral Breast ◽  
Unilateral Breast Cancer

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.

scholarly journals Contralateral risk reducing mastectomy in Non-BRCA-Mutated patients

Open Medicine ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. 238-241 ◽  
Author(s):  
Giuseppe Falco ◽  
Nicola Rocco ◽  
Daniele Bordoni ◽  
Luigi Marano ◽  
Antonello Accurso ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Contralateral Breast Cancer ◽  
Sporadic Breast Cancer ◽  
Genetic Mutation ◽  
Contralateral Breast ◽  
Moderate Risk ◽  
Unilateral Breast Cancer ◽  
Brca1 Brca2 ◽  
Genetic Assessment ◽  
Risk Reducing

AbstractThe use of contralateral risk reducing mastectomy (CRRM) is indicated in women affected by breast cancer, who are at high risk of developing a contralateral breast cancer, particularly women with genetic mutation of BRCA1, BRCA2 and P53. However we should consider that the genes described above account for only 20-30% of the excess familiar risk. What is contralaterally indicated when genetic assessment results negative for mutation in a young patient with unilateral breast cancer? Is it ethically correct to remove a contralateral “healthy” breast? CRRM rates continue to rise all over the world although CRRM seems not to improve overall survival in women with unilateral sporadic breast cancer. The decision to pursue CRRM as part of treatment in women who have a low-to-moderate risk of developing a secondary cancer in the contralateral breast should consider both breast cancer individual-features and patients preferences, but should be not supported by the surgeon and avoided as first approach with the exception of women highly worried about cancer. Prospective studies are needed to identify cohorts of patients most likely to benefit from CRRM.

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