Quality of Life After Contralateral Prophylactic Mastectomy in Newly Diagnosed High-Risk Breast Cancer Patients Who Underwent <i>BRCA1</i>/<i>2</i> Gene Testing

Tercyak, Kenneth P.; Peshkin, Beth N.; Brogan, Barbara M.; DeMarco, Tiffani A.; Pennanen, Marie; Willey, Shawna C.; Magnant, Colette; Rogers, S.; Isaacs, Claudine; Schwartz, Marc D.

doi:10.1200/jco.2006.07.3890

Cited by 73 publications

(66 citation statements)

References 36 publications

(11 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Previous observational studies support this position. 4,26 Finally, the results of the per-protocol analyses need to be interpreted with a great deal of caution, given the limited sample size available for these analyses and the concomitant limitations in the ability to detect statistically and clinically relevant differences in psychosocial outcomes. Larger studies are needed to confirm these results.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

“…10 This suggests that the observed distress was probably not due to having undergone RGCT. In a prospective, observational study, Tercyak et al 4 found no differences in quality of life or distress levels between women with breast cancer who had undergone RGCT and chose immediate CPM (n = 29) versus those who chose unilateral mastectomy or breast-conserving surgery (n = 118). This suggests that undergoing an immediate CPM does not cause additional distress.…”

mentioning

confidence: 98%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 98%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

show abstract

“…39 Several clinical studies have sought to understand the emotional impact on women who have undergone prophylactic surgery to eliminate cancer risk. 40 Those who opted for surgical methods reported more distress about their mutation carrier status than those who decided on medical surveillance and, in both the short and longer term, although their cancer risk worry was significantly reduced, their level of anxiety remained higher than for the surveillance group. 41 In other words, predictive genetic knowledge appears to be more worrisome for those with a propensity towards anxiety in general.…”

Section: Psychological and Counselling Studies: Decision-making Arounmentioning

confidence: 90%

Understanding the genetically at risk: clinical, psychological and social approaches

Turney

2009

Life Sci Soc Policy

View full text Add to dashboard Cite

The scientific discovery of a range of genetic mutations has meant that people with a strong family history of cancer can find out whether they are at risk of developing cancer well before they have any symptoms. Genetic testing has opened up the possibility for otherwise healthy mutation carriers to access prophylactic treatments in order to minimise their risk. These include surgery to remove at-risk body parts, treatment with cancer drugs, medical surveillance strategies, self-surveillance and change in lifestyle. Clinical experience to date has shown considerable resistance to the uptake of medical preventative measures despite their promise of risk reduction. This paper provides a summary review of the available literature on the medical, psychological, counselling and social aspects of genetic testing and the use of riskreducing treatments by people who have been diagnosed with a genetic predisposition to cancer. It acknowledges what has been learned from these approaches but points to the similarity of the philosophical underpinnings of most of the research. It concludes by tentatively making some suggestions, informed by the literature, about new directions for guiding our understanding the genetically at risk and the factors that influence their decision-making.

show abstract

“…Some studies showed that psychosocial effects and quality of life were similar in patients with and without prophylactic mastectomy (24)(25)(26), whereas other studies indicate that it has a negative impact on body image and sexuality (24)(25)(26). Therefore, when choosing the most appropriate surgical treatment for breast cancer in mutation carriers, psychosocial aspects should also be taken into consideration.…”

Section: Psychosocial and Emotional Effects Of Prophylactic Mastectomymentioning

confidence: 99%

Surgical Treatment of Breast Cancer in BRCA-Mutation Carriers

Özmen

2015

J Breasth Health

View full text Add to dashboard Cite

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...

show abstract

Quality of Life After Contralateral Prophylactic Mastectomy in Newly Diagnosed High-Risk Breast Cancer Patients Who Underwent BRCA1/2 Gene Testing

Abstract: With respect to quality of life and distress, patients who choose CPM fare as well as those who do not in the first year after surgery.

Cited by 73 publications

References 36 publications

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

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

Understanding the genetically at risk: clinical, psychological and social approaches

Surgical Treatment of Breast Cancer in BRCA-Mutation Carriers

Contact Info

Product

Resources

About