Prophylactic mastectomy for the prevention of breast cancer

Lostumbo, Liz; Carbine, Nora E; Wallace, Judi; Ezzo, Jeanette; Dickersin, Kay

doi:10.1002/14651858.cd002748.pub2

Cited by 160 publications

(143 citation statements)

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“…Although genetically enhanced medicine offers a variety of preventive measures, they provide no guarantees, and many significantly impact quality of life (Lostumbo, Carbine, Wallace, & Ezzo, 2004;Lux, Fasching, & Beckmann, 2006;Metcalfe, 2004). Non-invasive procedures that promote early detection, and thus reduce cancer mortality, include self-breast examination or transvaginal ultrasound at earlier ages and more frequently than the general population.…”

Section: Profile Of Brca Gene Alterationsmentioning

confidence: 99%

Beating the Biological Clock: The Compressed Family Life Cycle of Young Women with BRCA Gene Alterations

Werner‐Lin

2008

Social Work in Health Care

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Empirical and clinical literature suggests a temporal thread running through family narratives of hereditary disease, linking past experiences to current beliefs about risk. This study asked young women with elevated risk of developing hereditary breast or ovarian cancer (HBOC) how their family histories with cancer and their gene status inform meaning construction around cancer risk and family development. Twenty-three women aged 22-35 who carry a BRCA gene alteration completed illness genograms and open-ended, narrative interviews. Transcripts were analyzed using the Listening Guide, a narrative tool that emphasizes key themes, meanings, and relational structures. Data analysis revealed distinct priorities for (1) single versus partnered women and (2) women who wished to have children versus those who had completed childbearing or were not intending to have children. Findings suggest single women experience increased urgency at finding a life partner capable of handling the emotional strain of the cancer world and open to pursuing multiple paths toward parenthood. Further, participants' family experiences shaped beliefs about perceived time to achieve desired family goals, specifically having biological children, before a cancer diagnosis or the need for preventive surgery. Clinical practice and research implications are discussed.

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Section: Profile Of Brca Gene Alterationsmentioning

confidence: 99%

Beating the Biological Clock: The Compressed Family Life Cycle of Young Women with BRCA Gene Alterations

Werner‐Lin

2008

Social Work in Health Care

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“…Two retrospective studies have evaluated a heterogenic population of breast cancer patients with variable extent of family history and reported a reduction of contralateral breast cancer after CPM, but without improvement of overall survival in a follow-up period of 7 -10 years (Peralta et al, 2000;McDonnell et al, 2001). A recent systematic review included three additional studies; however, these lacked a comparison group and/or follow-up was not standardised (Lostumbo et al, 2004). Therefore, in the present study, the efficacy of CPM was investigated in a group of women with pathogenic BRCA1 or BRCA2 mutations and a personal history of unilateral invasive breast cancer.…”

mentioning

confidence: 99%

Risk reduction of contralateral breast cancer and survival after contralateral prophylactic mastectomy in BRCA1 or BRCA2 mutation carriers

et al. 2005

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The clinical outcome of contralateral prophylactic mastectomy (CPM) in women with a BRCA1 or BRCA2 mutation and a personal history of invasive breast cancer is unknown. We identified a cohort of 148 female BRCA1 or BRCA2 mutation carriers (115 and 33, respectively) who previously were treated for unilateral invasive breast cancer stages I -IIIa. In all, 79 women underwent a CPM, while the other women remained under intensive surveillance. The mean follow-up was 3.5 years and started at the time of CPM or at the date of mutation testing, whichever came last, that is, on average 5 years after diagnosis of the first breast cancer. One woman developed an invasive contralateral primary breast cancer after CPM, whereas six were observed in the surveillance group (Po0.001). Contralateral prophylactic mastectomy reduced the risk of contralateral breast cancer by 91%, independent of the effect of bilateral prophylactic oophorectomy (BPO). At 5 years follow-up, overall survival was 94% for the CPM group vs 77% for the surveillance group (P ¼ 0.03), but this was unexpectedly mostly due to higher mortality related with first breast cancer and ovarian cancer in the surveillance group. After adjustment for BPO in a multivariate Cox analysis, the CPM effect on overall survival was no longer significant. Our data show that CPM markedly reduces the risk of contralateral breast cancer among BRCA1 or BRCA2 mutation carriers with a history of breast cancer. Longer follow-up is needed to study the impact of CPM on contralateral breast cancer-specific survival. The choice for CPM is highly correlated with that for BPO, while only BPO leads to a significant improvement in overall survival so far. Women identified as carriers of a mutation in one of the breast and ovarian cancer-susceptibility genes BRCA1 or BRCA2 have strongly elevated risks of developing breast or ovarian cancer (Ford et al, 1998). A recent meta-analysis (Antoniou et al, 2003) including 22 studies, revealed an average cumulative risk of 65% for breast cancer and 39% for ovarian cancer in BRCA1 mutation carriers by age 70 years. The corresponding estimates for women with a mutation in BRCA2 were 45 and 11%. Once diagnosed with breast cancer, these women are also at high risk of developing breast cancer in the contralateral breast. Early reports of The Breast Cancer Linkage Consortium estimated a contralateral breast cancer cumulative risk of 50 -60% at age 70 years in BRCA1 or BRCA2 mutation carriers (Easton et al, 1995; The Breast Cancer Linkage Consortium, 1999). Later studies estimated even higher incidences of contralateral breast cancer within the first 5 years of follow-up after the primary breast cancer: 12 -33% among BRCA1 or BRCA2 mutation carriers (2.4 -6.5% per year) (Robson et al, 1998;Verhoog et al, 1998Verhoog et al, , 1999) as compared to a 0.4 -1% per year for breast cancer patients in general (Fisher et al, 1984).Owing to the elevated risks and fear of contralateral breast cancer, some women opt for contralateral prophylactic mastectomy (CPM). No stu...

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“…A recent Cochrane review showed that bilateral prophylactic (risk reduction) mastectomy reduced the incidence of, and death from, breast cancer, but it highlighted that more rigorous prospective studies are needed to assess absolute risk reduction. 16 The review also found that although contralateral prophylactic (risk reduction) mastectomy decreases the incidence of cancer in the contralateral breast, it is unclear whether, and for whom, this practice improves survival. 16 …”

Section: When and To Whom Should Breast Reconstruction Be Offered?mentioning

confidence: 99%

“…16 The review also found that although contralateral prophylactic (risk reduction) mastectomy decreases the incidence of cancer in the contralateral breast, it is unclear whether, and for whom, this practice improves survival. 16 …”

Section: When and To Whom Should Breast Reconstruction Be Offered?mentioning

confidence: 99%

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Post-mastectomy breast reconstruction

Thiruchelvam

McNeill

Jallali

et al. 2013

BMJ

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tion options with patients, irrespective of whether they are available locally. 6 Fifty three per cent of women having surgery for breast cancer will undergo mastectomy (box 1). 7 8 In the UK and United States, bilateral mastectomy is increasingly being used for risk reduction in BRCA carriers, for those with a high risk of developing breast cancer (lifetime risk of 30%), or as a planned management strategy for unilateral cancer (fig 1, bmj.com). 9-15 In general, bilateral mastectomy is associated with a higher rate of breast reconstruction. A recent Cochrane review showed that bilateral prophylactic (risk reduction) mastectomy reduced the incidence of, and death from, breast cancer, but it highlighted that more rigorous prospective studies are needed to assess absolute risk reduction. 16 The review also found that although contralateral prophylactic (risk reduction) mastectomy decreases the incidence of cancer in the contralateral breast, it is unclear whether, and for whom, this practice improves survival. 16 How is a mastectomy performed?When performing a mastectomy, the anatomical (oncological) plane between breast tissue and subcutaneous fat needs to be identified. It is, however, impossible to remove all breast tissue because the oncological plane is not uniform throughout the breast. A standard (simple) mastectomy removes the breast skin envelope, but a skin sparing mastectomy preserves the breast skin envelope Breast cancer is the most common cancer in women, with almost 1.38 million new cases a year worldwide; it accounts for 23% of all cancers and 14% of deaths from cancer. 1 However, mortality from breast cancer is d eclining-increasing numbers of women are long term survivors (>5 years) (currently 549 000 in the United K ingdom). 2 3 Surgery remains a mainstay of treatment, either breast conservation or mastectomy, but any breast surgery can greatly alter breast aesthetics and body image.Breast reconstruction restores breast symmetry after a mastectomy by creating a breast mound, similar in size, shape, contour, and "out of bra position" to the contralateral breast. In England and Wales in 2002, about 10% of women had immediate breast reconstruction; by 2009 this had risen to 21%. 4 Post-mastectomy breast reconstruction is associated with improved body image, quality of life, self confidence, and wellbeing. 5 In this review, we outline the indications for breast reconstruction along with the timing and techniques available to patients after mastectomy. What is post-mastectomy breast reconstruction?Breast reconstruction is a surgical procedure that restores shape to the breast after mastectomy. Although it will not re-create the exact look and feel of a natural breast, it aims to create a breast mound contour similar to that before mastectomy. When, and to whom, should breast reconstruction be offered?In 2009 the National Institute for Health and Clinical Excellence (NICE) revised guidance on improving breast cancer outcomes. It recommended discussing immediate reconstruction with all patients ha...

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Prophylactic mastectomy for the prevention of breast cancer

Cited by 160 publications

References 133 publications

Beating the Biological Clock: The Compressed Family Life Cycle of Young Women with BRCA Gene Alterations

Beating the Biological Clock: The Compressed Family Life Cycle of Young Women with BRCA Gene Alterations

Risk reduction of contralateral breast cancer and survival after contralateral prophylactic mastectomy in BRCA1 or BRCA2 mutation carriers

Post-mastectomy breast reconstruction

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