Contralateral mastectomy and survival after breast cancer in carriers of BRCA1 and BRCA2 mutations: retrospective analysis

Abstract

Objective To compare the survival rates of women with BRCA associated breast cancer who did and did not undergo mastectomy of the contralateral breast. Design Retrospective analysis.Setting 12 cancer genetics clinics.Participants 390 women with a family history of stage I or II breast cancer who were carriers of BRCA1 and BRCA2 mutations and initially treated with unilateral or bilateral mastectomy. 181 patients had mastectomy of the contralateral breast. Patients were followed for up to 20 years from diagnosis. Main outcome measure Death from breast cancer.Results 79 women died of breast cancer in the follow-up period (18 in the bilateral mastectomy group and 61 in the unilateral mastectomy group). The median follow-up time was 14.3 years (range 0.1-20.0 years). At 20 years the survival rate for women who had mastectomy of the contralateral breast was 88% (95% confidence interval 83% to 93%) and for those who did not was 66% (59% to 73%). In a multivariable analysis, controlling for age at diagnosis, year of diagnosis, treatment, and other prognostic features, contralateral mastectomy was associated with a 48% reduction in death from breast cancer (hazard ratio 0.52, 95% confidence interval 0.29 to 0.93; P=0.03). In a propensity score adjusted analysis of 79 matched pairs, the association was not significant (0.60, 0.34 to 1.06; P=0.08). Based on these results, we predict that of 100 women treated with contralateral mastectomy, 87 will be alive at 20 years compared with 66 of 100 women treated with unilateral mastectomy. ConclusionsThis study suggests that women who are positive for BRCA mutations and who are treated for stage I or II breast cancer with bilateral mastectomy are less likely to die from breast cancer than women who are treated with unilateral mastectomy. Given the small number of events in this cohort, further research is required to confirm these findings.

Improved overall survival after contralateral risk‐reducing mastectomy in BRCA1/2 mutation carriers with a history of unilateral breast cancer: A prospective analysis

“…19,21 In the British study, describing a cohort of 698 BRCA-associated PBC patients of whom 105 (15%) opted for CRRM (median follow-up period 9 years), 10-year overall survival was 89% in the CRRM group and 71% in the non-CRRM group. Due to differences in study design, though, it is difficult to directly compare the results of this study with our findings.…”

“…So far, data on survival of PBC patients who opt for subsequent CRRM are inconsistent. Some studies showed improved survival after CRRM, 14,17,[19][20][21] while others did not. 11,13,16,18 Also, previous studies often suffered from small sample sizes, 11,13,18 short follow-up 13,18,20 and heterogeneous study populations consisting of mixtures of sporadic, high-risk and BRCA-associated PBC patients.…”

“…16,18 In fact, only three studies exclusively reported on BRCA1/2 mutation carriers. 13,19,21 More knowledge on the efficacy of CRRM after BRCAassociated PBC is important as this allows for more accurate and tailored genetic and oncologic counselling for respective patients. In view of the limitations of previous studies, we designed a well-powered prospective study to establish the efficacy of CRRM after BRCA-associated PBC on overall survival.…”

Does rapid genetic counseling and testing in newly diagnosed breast cancer patients cause additional psychosocial distress? results from a randomized clinical trial

“…[2][3][4] Several studies have shown that a CPM leads to a large reduction (up to 95%) in the risk of contralateral breast cancer, with increasing evidence of improved breast cancer-specific survival. 5,6 Advances in the technology and logistics of genetic testing of the BRCA1 and BRCA2 genes have made it possible to offer high-risk breast cancer patients the opportunity to undergo rapid genetic counseling and testing (RGCT) during the time period between diagnosis and primary surgery. Women who Purpose: Female breast cancer patients carrying a BRCA1/2 mutation have an increased risk of second primary breast cancer.…”

Bilateral Mastectomy for Unilateral Breast Cancer: a Perplexing Trend

“…During the last 15 years, several observation studies have shown improved survival rates among women who undergo CPM versus unilateral mastectomy [6,[13][14][15][16][17][18][19]. These reports have likely influenced surgical decision-making, and may also partly account for the rapid increase in utilization of CPM.…”