Contralateral prophylactic mastectomy

Abstract

BACKGROUND Women with unilateral breast carcinoma are at increased risk for developing contralateral breast carcinoma (CBC). The authors sought to identify predictors of malignant or moderate to high‐risk histologic findings in contralateral prophylactic mastectomy (CPM) specimens, and to determine the efficacy of CPM. METHODS The authors performed a retrospective review of 239 patients with unilateral early‐stage breast carcinoma who underwent CPM. The number of CBCs expected if the contralateral breast had been left intact was calculated based on CBC rates observed in the Surveillance, Epidemiology, and End Results (SEER) database and on life‐table analysis by family history. RESULTS In the current study, 11 patients (4.6%) had occult contralateral malignancies (4 invasive carcinomas and 7 ductal carcinomas in situ) and 44 (18.4%) patients had moderate to high‐risk pathology (8 lobular carcinoma in situ, 11 atypical lobular hyperplasia, 25 atypical ductal hyperplasia). At 1846 patient‐years of follow‐up, only 1 patient (0.4%) developed a new CBC compared with 11 expected cancers based on SEER data. One CBC was observed among 140 patients with a family history of breast carcinoma, compared with 16 expected cancers based on life‐table analysis adjusted for adjuvant therapy. The determinants of significant findings at CPM were invasive lobular histology, estrogen and progesterone receptor positivity, additional ipsilateral moderate to high‐risk pathology, and age > 40 years at cancer diagnosis. CONCLUSIONS CPM was associated with a low risk of subsequent development of breast carcinoma. Evaluation of histologic findings in the ipsilateral breast may help to predict the likelihood of significant disease in the contralateral breast and assist in risk stratification. Cancer 2004. © 2004 American Cancer Society.

Factors Affecting the Decision of Breast Cancer Patients to Undergo Contralateral Prophylactic Mastectomy

“…In considering the risk of the proposed surgery, one must also consider how the surgery will effect adjuvant therapy; even minor wound complications may potentially delay recommended chemotherapy or radiation therapy for the primary cancer after surgery. Indeed, in a previous study, we found that bilateral mastectomy for unilateral cancer conferred a higher risk of complications than unilateral mastectomy, with 8.4% of the complications occurring on the primary side, 6.3% occurring on the contralateral side, and 1.7% occurring bilaterally; thus, CPM does increase the complexity of the surgical procedure and may increase the complications incurred 1 .…”

“…Women diagnosed with breast cancer have a significantly increased lifetime risk of developing contralateral breast cancer (CBC) over the general population 1–4 . Gao et al evaluated the incidence of CBC in 134,501 patients previously diagnosed with breast cancer identified from the Surveillance, Epidemiology, and End Results (SEER) database and found that the actuarial incidence of CBC at 5, 10, 15, and 20 years was 3%, 6.1%, 9.1%, and 12%, respectively, or approximately 0.6% per year 5 .…”

Predictors that Influence Contralateral Prophylactic Mastectomy Election Among Women with Ductal Carcinoma In Situ Who Were Evaluated for BRCA Genetic Testing

“…9,7,21,23 In a prospective study, Meijers-Heijbor et al 20 evaluated the incidence of BC among 139 BRCA1 and BRCA2 mutation carriers who elected to undergo either BPM or close surveillance only. During an average follow-up interval of 3 years, 8 of the 63 women in the surveillance group developed BC, whereas none of the 76 women in the prophylactic-mastectomy group developed BC.…”

“…Goldflam and colleagues 23 found evidence that family history of BC was mostly associated with CPM. They retrospectively reviewed data for 239 patients with unilateral early-stage BC who elected to undergo CPM, and family history of BC was the most frequent reason given to undergo CPM in more than half of the patients.…”

Impact of Reconstruction and Reoperation on Long-Term Patient-Reported Satisfaction After Contralateral Prophylactic Mastectomy

“…(18) Studies have shown that the complication rate associated with CPM is similar to the rate of complication for surgery on the side of the index breast cancer and thus CPM at time of therapeutic mastectomy leads to a doubling of the complication rate. (19,20) The majority of women who elect CPM elect immediate breast reconstruction. (21) Immediate breast reconstruction is associated with higher rates of complications and reoperation (22,23) compared to mastectomy without reconstruction.…”