Contralateral Prophylactic Mastectomy After Unilateral Breast Cancer

Fayanju, Oluwadamilola M.; Stoll, C; Fowler, Susan A.; Colditz, Graham A.; Margenthaler, Julie A.

doi:10.1097/sla.0000000000000769

Cited by 108 publications

(79 citation statements)

References 76 publications

(151 reference statements)

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“…The rate of contralateral prophylactic mastectomy (CPM) for surgical treatment of unilateral breast cancer has risen dramatically in the past 15 years. [1][2][3][4][5][6][7] Multiple studies have questioned the benefit of CPM because it does not improve survival in average-risk women [8][9][10][11][12][13] and may increase cost 14,15 and complications. 8,16,17 Numerous studies investigating the increasing use of CPM have identified significant factors related to patient, surgeon, and treatment facility.…”

mentioning

confidence: 98%

Variation in Contralateral Prophylactic Mastectomy Rates According to Racial Groups in Young Women with Breast Cancer, 1998 to 2011: A Report from the National Cancer Data Base

Grimmer

Liederbach

Velasco

et al. 2015

Journal of the American College of Surgeons

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mentioning

confidence: 98%

Variation in Contralateral Prophylactic Mastectomy Rates According to Racial Groups in Young Women with Breast Cancer, 1998 to 2011: A Report from the National Cancer Data Base

Grimmer

Liederbach

Velasco

et al. 2015

Journal of the American College of Surgeons

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“…Local recurrence after mastectomy for breast cancer in BRCA mutation carriers There is only one study comparing local recurrence in BRCA mutation carriers with breast cancer after mastectomy and breast conserving surgery (16,17). This study reported quite high local recurrence rates after 15 years in BCS (23.5% and 5.5%), however, breast cancer specific (92.8% and 93.5%) and overall survival rates (89.8% and 93.8%) were similar.…”

Section: Right Mastectomy and Sentinel Lymph Node Biopsymentioning

confidence: 57%

“…Adjuvant chemotherapy and BSO reduces local recurrence by 50% in the same breast: BRCA1/2-associated breast cancer is more sensitive to chemotherapy, in addition, the observed reduction in risk in carrier patients with breast cancer and BSO is similar to the risk reduction by BSO in carriers without breast cancer (17). Consequently, in carriers with breast cancer, aggressive surgery (mastectomy, mastectomy + contra-lateral prophylactic mastectomy) may be more appropriate if BSO is not performed.…”

Section: Right Lumpectomy + Slnbmentioning

confidence: 68%

Surgical Treatment of Breast Cancer in BRCA-Mutation Carriers

Özmen

2015

J Breasth Health

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Approximately 20 years after identification of mutations in genes associated with breast cancer (BRCA-1,2), the number of women having BRCA-1,2 tests doubled after the famous artist Angelina Jolie who was a BRCA-1 carrier underwent bilateral prophylactic mastectomy (1). The number of women having prophylactic bilateral mastectomy based on a positive test is also increasing. These results emphasize the role of a well-known person in creating awareness.Breast-conserving surgery has been a standard in breast cancer surgery for nearly thirty years, and currently lack of ink staining on the specimen is considered as a negative surgical margin. However, the surgical treatment of women diagnosed with breast cancer and carry BRCA-1,2 is not yet standard. In this group of patients, the treatment of choice is bilateral subcutaneous mastectomy and salpingooophorectomy over the age of 40 years, while at a younger age, in patients who desire to give birth and breastfeed; the decision to choose such a treatment is usually difficult.Currently, it is accepted that the diagnosis and treatment of breast cancer should be individualized, and planning should be made according to the patient's and the tumor's clinical and genetic characteristics. Similarly, the decision for surgical treatment should be based on patient' age and tumor characteristics in BRCA 1,2 carriers. This article focuses on an actual young, nulliparous patient who was diagnosed with breast cancer. Case PresentationOur patient AK is 33 years old, has a mass in the upper outer quadrant of the right breast. She is nulliparous, age at first menstruation is 9 years. On physical examination, both breasts are dense; there is a 15 mm nodular mass on her right breast at 9 o'clock position, with no palpable axillary node. On mammography an asymmetrical density, and on ultrasonography a lobulated, hypovascular mass was observed on her right breast, which was considered as degenerated fibroadenoma (Figure 1, 2). On MRI, the lesion on the upper outer quadrant of the right breast showed cystic degeneration and Type II curve (Figure 3). The tru-cut biopsy was invasive ductal carcinoma, with triplenegative molecular subtype. Pedigree history showed that her mother's grandmother and mother's aunt had breast, her grandmother and mother had ovarian cancer. Her genetic testing for BRCA 1 and 2 mutations was positive. In addition, she had clinical stage I breast cancer. QuestionIf this patient diagnosed with right breast cancer, and she did not have BRCA mutation, which type of surgery would be suggested?1. Lumpectomy + sentinel lymph node biopsy (SLNB) 2. Mastectomy + SLNB 3. Subcutaneous mastectomy + silicone prosthesis reconstruction + SLNB AnswerIn a patient with right-sided breast cancer and no genetic carrier status, the ideal surgical treatment to be offered is lumpectomy-SLNB, if the breast tumor ratio is appropriate. If the patient previously received radiation therapy to the chest wall, or radiation therapy is contraindicated due to collagen disease (lupus erythematosus, de...

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“…8 As a preventive measure, CRRM in patients with no demonstrated increased genetic risk remains controversial. The potential benefits include a reduction of breast cancer occurrence and decreased psychological distress, but in a recent meta-analysis 9 it was showed that there is no survival advantage from CRRM in women who are not at high-risk.…”

mentioning

confidence: 96%