Contralateral prophylactic mastectomy in breast cancer patients who test negative for BRCA mutations

doi:10.1016/j.amjsurg.2011.04.001

The American Journal of Surgery

Volume 202, Issue 3, September 2011, Pages 298-302

https://doi.org/10.1016/j.amjsurg.2011.04.001 Get rights and content

Abstract

Background

Determination of BRCA1 and 2 mutation carrier status is important. Although BRCA carriers are offered bilateral mastectomy and oophorectomy, most who test negative decline. Some women choose contralateral prophylactic mastectomy (CPM) at the time of their breast cancer diagnosis despite testing negative.

Methods

A total of 110 women with breast cancer received genetic testing before surgical treatment. Patient demographics, tumor characteristics, surgical treatment, and magnetic resonance imaging use were recorded.

Results

Results revealed BRCA1/2 mutation in 33%, variant of unknown significance in 6%, and no mutation in 61% of women. In BRCA-negative women, 37% chose CPM. Marital status was significant for CPM (P = .03). Race, age, stage of presentation, and biomarker status were not associated with choice of CPM. Ninety-six percent of CPM recipients underwent breast reconstruction. Magnetic resonance imaging use did not affect CPM rates (P = .99).

Conclusions

Increased rates of CPM have been observed. In our study married women were more likely to choose CPM. We recommend genetic genotyping before surgery. These findings warrant further investigation.

Section snippets

Materials and methods

This study was approved by the institutional review board at Wake Forest University. We retrospectively examined the charts from women diagnosed with breast cancer who received preoperative genetic counseling and testing at Wake Forest between January 2005 and June 2009. Additional information was obtained from a query of a prospectively maintained genetic counseling database maintained by the Surgical Oncology Program. The genetic counseling was performed by our genetic counselor (G.J.H.).

Results

We identified 110 women with newly diagnosed breast cancer who underwent preoperative genetic counseling and testing before undergoing definitive surgical treatment from 2005 to 2009. The mean patient age at breast cancer diagnosis was 45 years (range, 30–80 y). Results revealed BRCA1, a known deleterious mutation, in 32 (29%) women, BRCA2 mutation in 4 (3%), variant of unknown significance in 7 (6%), and no mutation in 67 (61%) patients. Patient, tumor, and treatment characteristics of the 65

Comments

The preferred treatment of breast cancer has evolved from the Halstedian radical mastectomy to modified radical mastectomy, to breast-conserving surgery. Since the National Cancer Institute's 1991 consensus statement, breast-conserving surgery has been the treatment of choice for early stage breast cancers.⁸ However, at the time of the consensus statement, genotyping for familial breast cancer conditions such as the BRCA1 and 2 mutations was not yet possible. Recently there has been a trend

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Cited by (22)

Contralateral prophylactic mastectomy in an Asian population: A single institution review
2014, Breast
Citation Excerpt :
This is similar to the retrospective study by Jones et al. [11] where the women who chose CPM were younger and had a lower stage of breast cancer. The majority of CPM patients were married (60%) and had a religion (60%), comparable to previous studies [33,34], although the reasons for this correlation would be better explored in a prospective study or survey. Two-thirds of the women underwent CPM surgery as the same setting as their mastectomy.
Contralateral prophylactic mastectomy (CPM) removes the non-diseased breast in women who have unilateral breast cancer. This reduces the incidence of contralateral breast cancer, and potentially improves survival in high risk patients. Such surgical risk-reduction strategy is increasingly being adopted in the United States, despite a decreasing incidence of contralateral breast cancer. The use of CPM in an Asian population is yet unknown. We present the first Asian report on CPM rates and trends in Singapore, the country with the highest incidence of breast cancer in Asia.
A retrospective review of all patients who had breast cancer surgery from 2001 to 2010 at the largest healthcare system in Singapore was performed. Patient demographics and tumour characteristics were analysed with regards to type of surgery performed. Factors associated with CPM were identified.
From 2001 to 2010, a total of 5130 patients underwent oncological breast surgery. A decreasing trend of mastectomies (82.7%–70.8%), an upward trend of breast conserving surgery (BCS) (17.3%–29.2%) and an increasing trend in CPM (0.46%–1.25%) is observed. Patients who opted for CPM are likely to be younger (48.4 ± 9.4 years), married (60%), parous (56.7%), with no family history of breast/ovarian cancer (66.7%), and diagnosed at an earlier stage. The rate of synchronous occult breast malignancy was found to be 10% (n = 30), and these were in patients who were of a low cancer-risk profile.
This retrospective study reflects an increasing incidence of breast cancer in Singapore, with a decrease in mastectomies, and an increase in BCS and CPM rates, similar to Western data. Similar to Western populations, the Asian woman who opts for CPM is likely to be young and have an earlier stage of breast cancer. In contrast, the Asian woman is likely to have no family history of breast or ovarian cancers. Commonly cited reasons for increased CPM rates such as the increased availability of genetic counselling and pre-operative MRI evaluation, along with wide use of reconstruction, do not feature as dominant factors in our population, suggesting that the Asian patients may have different considerations when electing for CPM.
Attitudes toward Risk-Reducing Mastectomy and Risk-Reducing Salpingo-oophorectomy among Young, Unmarried, Healthy Women in Korea
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Clinical management among individuals with variant of uncertain significance in hereditary cancer: A systematic review and meta-analysis
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Health Disparities in Germline Genetic Testing for Cancer Susceptibility
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Predictors of contralateral prophylactic mastectomy in genetically high risk newly diagnosed breast cancer patients
2020, Breast Cancer Research and Treatment
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Clinical scienceContralateral prophylactic mastectomy in breast cancer patients who test negative for BRCA mutations

Abstract

Background

Methods

Results

Conclusions

Section snippets

Materials and methods

Results

Comments

Am J Hum Genet

Prevalence of pathogenic BRCA1 mutation carriers in 5 US racial/ethnic groups

JAMA

American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography

CA Cancer J Clin

Genetic familial high-risk assessment: breast and ovarian

Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment

J Clin Oncol

Efficacy of prophylactic mastectomy in women with unilateral breast cancer: a cancer research network project

J Clin Oncol

Treatment of early-stage breast cancer

JAMA

Contralateral prophylactic mastectomy is associated with a survival advantage in high-risk women with a personal history of breast cancer (abstr)

Ann Surg Oncol

Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ

J Clin Oncol

Trends in mastectomy rates at the Mayo Clinic Rochester: effects of surgical year and preoperative magnetic resonance imaging

J Clin Oncol

Diagnostic breast magnetic resonance imaging and contralateral prophylactic mastectomy

Ann Surg Oncol

Patient and tumor characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer

Ann Surg Oncol

Clinical science
Contralateral prophylactic mastectomy in breast cancer patients who test negative for BRCA mutations