Prophylactic mastectomy for the prevention of breast cancer

Lostumbo, Liz; Carbine, Nora E; Wallace, Judi

doi:10.1002/14651858.cd002748.pub3

Cited by 235 publications

(108 citation statements)

References 97 publications

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“…6 Factors thought to decrease MPBC risk have also been identified, and include menarche after age 13, multiparity, 17 treatment with anti-hormonal agents or chemotherapy 22,23 and prophylactic surgical intervention. 24 These findings suggest that multiple primary BC risk can be impacted by estrogen alterations either before or after the first BC diagnosis.…”

Section: Introductionmentioning

confidence: 86%

Estrogen withdrawal, increased breast cancer risk and the KRAS-variant

et al. 2015

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Keywords: breast cancer risk, estrogen withdrawal, KRAS-variant, multiple primary breast cancer, triple negative breast cancer, tumor biologyThe KRAS-variant is a biologically functional, microRNA binding site variant, which predicts increased cancer risk especially for women. Because external exposures, such as chemotherapy, differentially impact the effect of this mutation, we evaluated the association of estrogen exposures, breast cancer (BC) risk and tumor biology in women with the KRAS-variant. Women with BC (n D 1712), the subset with the KRAS-variant (n D 286) and KRAS-variant unaffected controls (n D 80) were evaluated, and hormonal exposures, KRAS-variant status, and pathology were compared. The impact of estrogen withdrawal on transformation of isogenic normal breast cell lines with or without the KRAS-variant was studied. Finally, the association and presentation characteristics of the KRAS-variant and multiple primary breast cancer (MPBC) were evaluated. KRAS-variant BC patients were more likely to have ovarian removal pre-BC diagnosis than non-variant BC patients (p D 0.033). In addition, KRAS-variant BC patients also appeared to have a lower estrogen state than KRAS-variant unaffected controls, with a lower BMI (P < 0.001). Finally, hormone replacement therapy (HRT) discontinuation in KRAS-variant patients was associated with a diagnosis of triple negative BC (P < 0.001). Biologically confirming our clinical findings, acute estrogen withdrawal led to oncogenic transformation in KRAS-variant positive isogenic cell lines. Finally, KRAS-variant BC patients had greater than an 11-fold increased risk of presenting with MPBC compared to non-variant patients (45.39% vs 6.78%,.87], P < 0.001). Thus, estrogen withdrawal and a low estrogen state appear to increase BC risk and to predict aggressive tumor biology in women with the KRAS-variant, who are also significantly more likely to present with multiple primary breast cancer.

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Section: Introductionmentioning

confidence: 86%

Estrogen withdrawal, increased breast cancer risk and the KRAS-variant

et al. 2015

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“…[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.…”

Section: Introductionmentioning

confidence: 99%

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

Wevers

Ausems

Verhoef

et al. 2016

Genetics in Medicine

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Original research article IntroductIonFemale breast cancer patients who carry a BRCA1 or BRCA2 gene mutation have an increased risk of 20-55% for developing a second primary breast cancer 1 and are at increased risk for ovarian cancer. The risk of contralateral breast cancer is highest for carriers who were diagnosed with their first breast cancer at a young age. 1 Between 18 and 29% of carriers with a favorable prognosis opt for immediate or, more often, delayed contralateral prophylactic mastectomy (CPM) to reduce their risk of a second breast cancer. [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. Rapid genetic counseling and testing (RGCT) before surgery may influence choice of primary surgical treatment. In this article, we report on the psychosocial impact of RGCT. Methods:Newly diagnosed breast cancer patients at risk for carrying a BRCA1/2 mutation were randomized to an intervention group (offer of RGCT) or a usual care control group (ratio 2:1). Psychosocial impact and quality of life were assessed with the Impact of Events Scale, Hospital Anxiety and Depression Scale, Cancer Worry Scale, and the EORTC QLQ-C30 and QLQ-BR23. Assessments took place at study entry and at 6-and 12-month follow-up visits.results: Between 2008 and 2010, 265 patients were recruited into the study. Completeness of follow-up data was more than 90%. Of the 178 women in the intervention group, 177 had genetic counseling, of whom 71 (40%) had rapid DNA testing and 59 (33%) received test results before surgery. Intention-to-treat and per-protocol analyses showed no statistically significant differences between groups over time in any of the psychosocial outcomes. conclusions:In this study, RGCT in newly diagnosed breast cancer patients did not have any measurable adverse psychosocial effects.

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“…3,4 Although a significant improvement in survival has not been identified in most studies, a more recent study has demonstrated a modest survival benefit for women under 50. 5,6 Prophylactic mastectomy is usually reserved for patients who are at high risk for developing a contralateral breast cancer. The Society of Surgical Oncology's Position Statement on prophylactic mastectomy reports that CPM is potentially indicated in women at higher risk, such as those with BRCA1-2 gene mutations, atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, difficulty in following the contralateral breast radiologically or clinically, or for cosmesis.…”

mentioning

confidence: 99%

Mastectomy and Contralateral Prophylactic Mastectomy Rates: An Institutional Review

Damle

Teal

Lenert

et al. 2011

Indian J Surg Oncol

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Background. Breast conservation surgery (BCS) followed by radiation is as effective as mastectomy for long-term survival and is considered standard of care for early-stage breast cancer. An increasing number of patients are opting for cancer-side mastectomies (CM) and often contralateral prophylactic mastectomies (CPM). Our study investigates if there are increasing trends in our patient population toward CM and CPM and identifies common factors associated with those electing to have more extensive surgery. Methods. A retrospective analysis was performed on 812 breast cancer surgeries between January 2001 and December 2009 at The George Washington University Breast Care Center. BCS-eligible patients who elected to have BCS were compared with those who chose CM. Patients who underwent CM were compared with patients undergoing CM and CPM. Results. A personal or family history of breast cancer and larger tumor size were positively associated with choosing CM in BCS-eligible patients. A nonstatistically significant trend toward CM was seen in younger patients. Age, family history, fewer children, Caucasian race, and reconstructive surgery were positively associated with choosing CPM. Conclusion. Mastectomy rates at this institution have not shown the recent sharp increase observed by some authors. The association of age, race, family history, and parity with CPM has been corroborated in multiple studies. However, there is disagreement between statistically significant findings among investigators evaluating factors associated with CPM, and there is limited data in the literature characterizing BCS-eligible patients who chose CM. Larger prospective studies are necessary to further evaluate CM and CPM rates.In 1991, The National Institutes of Health issued a consensus statement advocating breast conservation surgery (BCS) as the preferred surgical treatment for earlystage breast cancer.1 Despite this long-standing recommendation, not all eligible patients receive this treatment. Furthermore, some institutions have noted an increasing trend in cancer-side mastectomy (CM) rates. In a 13-year institutional analysis of 5865 patients, McGuire and colleagues noted a rise in CM rates from 31% in 1997 to almost 60% in 2007. The authors cited possible reasons for this trend such as increased detection of additional foci, genetic testing, improved reconstruction techniques, and increased patient demand. Contralateral prophylactic mastectomy (CPM) reduces the risk of breast cancer by 91-96%.3,4 Although a significant improvement in survival has not been identified in most studies, a more recent study has demonstrated a modest survival benefit for women under 50. 5,6 Prophylactic mastectomy is usually reserved for patients who are at high risk for developing a contralateral breast cancer. The Society of Surgical Oncology's Position Statement on prophylactic mastectomy reports that CPM is potentially indicated in women at higher risk, such as those with BRCA1-2 gene mutations, atypical ductal hyperplasia, atypical lobular ...

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Prophylactic mastectomy for the prevention of breast cancer

Cited by 235 publications

References 97 publications

Estrogen withdrawal, increased breast cancer risk and the KRAS-variant

Estrogen withdrawal, increased breast cancer risk and the KRAS-variant

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

Mastectomy and Contralateral Prophylactic Mastectomy Rates: An Institutional Review

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