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

Abstract

Background Patients with ductal carcinoma in situ (DCIS) are at increased risk for developing contralateral breast cancer (CBC). Consequently, more women with DCIS are electing contralateral prophylactic mastectomy (CPM). We evaluated factors associated with CPM in patients with DCIS who underwent genetic counseling for BRCA testing. Methods This retrospective study involved 165 women with DCIS referred for genetic counseling between 2003 and 2011. Patient characteristics were age, marital and educational status, tumor markers, nuclear grade, family history of breast cancer (BC) and ovarian cancer (OC), race, Ashkenazi Jewish ancestry, and BRCA results. Univariate and multivariate logistic regression analyses were used to determine predictive factors associated with CPM election. Results Of 165 patients, 44 (27%) underwent CPM. Patients < 45 years were more likely to elect CPM (P = .0098). A BRCA+ mutation was found in 17 patients (10.3%), and BRCA+ women were more likely to elect CPM than BRCA- or untested women (P = 0.0001). Patients who had a family history of OC (57.7%) were more likely to choose CPM than those with no family history (P = 0.0004). Younger age, BRCA+, and an OC family history remained significant in the multivariate model (P < 0.008). Conclusion The CPM rate among patients with DCIS who undergo genetic counseling is high. Factors associated with increased likelihood of CPM among this group were age, BRCA+, and a family history of OC. Further studies are needed to evaluate patients' perceptions of CBC risk and their role in the likelihood of CPM choice.

Predictors that Influence Election of Contralateral Prophylactic Mastectomy among Women with Ductal Carcinoma in Situ who are BRCA-Negative

“…Our recent previous study examined CPM among patients with DCIS who were either BRCA- positive , BRCA- negative, or untested 3. In that study, 165 patients (27%) elected CPM.…”

“…Among women with DCIS and a negative BRCA result, 25% elected CPM 3. This relatively high rate warranted further investigation to elucidate possible predictive factors of CPM in this specific group.…”

“…Increasing numbers of women with DCIS are electing contralateral prophylactic mastectomy (CPM),2,3 with studies indicating a four-to five-fold increase in CPM in recent years 4. In a study of 2,037 DCIS patients, 37% (<40 years) elected CPM, and 82% (<40 years) had immediate reconstruction 3. Additionally, Ashfaq et al found that a significantly higher proportion of patients undergoing CPM had reconstruction performed (46%) than those who did not elect CPM (15%) 5…”

Should local treatment of breast ductal carcinoma in situ be the same as the treatment of early invasive breast cancer

“…The choice of the optimum scope of locoregional treatment is usually assisted with the assessment of the prognostic value of the Van Nuys Prognostic Index (VNPI), worked out in 2002 or VNPI/SCI, corrected in 2009 [7]. Amongst the tools recommended for a more specific prediction of the course of the disease, are also genetic tests, including Oncotype DX and the examination of the BRCA1 and BRCA2 gene mutation [8,9].…”

“…In the USA, after the period of a decrease in the number of mastectomies in 1998-2004 (from 36 to 28%), since 2011 a further growth in the number of breast amputations, following the diagnose of DCIS has been observed, correlating additionally with the increase of the contralateral breast amputation. This concerns mostly younger patients, BRCA1 gene carriers, in particular, in families with a family history burdened with ovarian cancer [9]. An additional argument for this option is the reluctance for revision surgeries necessary to obtain a cancer-free margin, chimeric course of the disease in spite of a lack of any signs of invasion, the possibility to avoid radiotherapy and access to the procedures of immediate breast reconstruction [13][14][15].…”