Bilateral Prophylactic Mastectomy in Swedish Women at High Risk of Breast Cancer

Arver, Brita; Isaksson, Karin; Atterhem, Hans; Baan, Annika; Bergkvist, Leif; Brandberg, Yvonne; Ehrencrona, Hans; Emanuelsson, Monica; Hellborg, Henrik; Henriksson, Karin; Karlsson, Per; Loman, Niklas; Lundberg, Jonas; Ringberg, Anita; Askmalm, Marie Stenmark; Wickman, Marie; Sandelin, Kerstin

doi:10.1097/sla.0b013e318214b55a

Cited by 53 publications

(38 citation statements)

References 45 publications

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“…However, AdH, which is considered to be a premalignant lesion, was found in 10% of our patients. In a recent Swedish study of Arver et al (25), premalignant or malignant lesions were found in 10% of patients, which coincides with the results of our study; in addition, there were also 2% of invasive cancers in their series.…”

Section: Reconstruction N=27supporting

confidence: 92%

The frequency and outcome of breast cancer risk-reducing surgery in finnish BRCA1 and BRCA2 mutation carriers

et al. 2013

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IntroductIon the cumulative lifetime risk of having breast cancer is 65% (44%−78%) in BRCA1 gene mutation carriers and 45% (31%−56%) in BRCA2 carriers. For ovarian cancer, the risks are 39% (18%−54%) and 11% (2.4%−19%) for BRCA1 and BRCA2 carriers, respectively (1). risk management strategies in women with BRCA1 or BRCA2 mutation include cancer screening, chemoprevention, or risk-reducing surgery (2). cancer screening by different modalities aims at early detection of breast cancer, when it still is curable by appropriate treatment. Present recommendations for surveillance include annual breast magnetic resonance imaging (MrI), mammography, and ultrasound in addition to clinical breast examination and breast self-examination. the combination of MrI, mammography, and ultrasound has a sensitivity of 95% versus 45% for mammography as the only modality (3). THE FREQUENCY AND OUTCOME OF BREAST CANCER RISK-REDUCING SURGERY IN FINNISH

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Section: Reconstruction N=27supporting

confidence: 92%

The frequency and outcome of breast cancer risk-reducing surgery in finnish BRCA1 and BRCA2 mutation carriers

et al. 2013

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“…Surgical techniques and breast reconstruction have been described in detail previously and were not changed during the study period (3,4). In brief, a subcutaneous skin-sparing mastectomy with immediate implant-based breast reconstruction was performed, using expandable or permanent implants.…”

Section: Methodsmentioning

confidence: 99%

“…Women with a family history of breast cancer and/or identified BRCA mutations may opt for bilateral risk-reducing mastectomy (BRRM), whereas patients with a personal history of breast cancer may consider contralateral risk-reducing mastectomy (CRRM). RRM is irrevocable and includes issues of psychological distress, negative impact on body image, sexual functioning and potential surgical complications (3). The clinical course for patients undergoing contralateral RRM, evaluated in median 4 years later, showed that 60% required at least one reoperation (4).…”

Section: Introductionmentioning

confidence: 99%

Preoperative psychosocial characteristics may predict body image and sexuality two years after risk-reducing mastectomy: a prospective study

Unukovych¹,

Johansson²,

Brandberg³

2017

Gland Surg.

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Background: Risk-reducing mastectomy (RRM) in patients at high risk has become more available and the rates of both bilateral (BRRM) and contralateral (CRRM) procedures are increasing. For women opting for RRM, psychosocial well-being, body image and sexuality are known to be important patient-reported outcomes. The aim of the present study was to investigate baseline health-related quality of life (HRQoL) and emotional distress (anxiety and depression) as predictors of body image and sexuality two years after RRM in women undergoing CRRM and BRRM.Methods: This is a prospective cohort study including consecutive women opting for BRRM and breast cancer patients considering CRRM at Karolinska University Hospital during 1998-2010. The women were given a set of questionnaires to be completed at baseline before RRM (The Medical Outcomes Study 36-Item Short Form, The Hospital Anxiety and Depression Scale, and The Sexual Activity Questionnaire) and two years after RRM (all the above-mentioned questionnaires along with The Body Image Scale). Mean scores for all questionnaires were analysed using linear regression models and adjusted for age at RRM as well as calendar year.Results: In total, 253 patients consented to participate in the study. Response rate at baseline and 2 years was 88% and 71%, respectively. In the BRRM group (healthy women), preoperative HRQoL and emotional distress were associated with body image and sexual problems two years after the procedure. No similar associations were found for the patients with breast cancer who underwent CRRM. Conclusions:The current study suggests that preoperative HRQoL and emotional distress may predict body image and sexual problems two years after RRM in healthy women, but not in breast cancer patients.Baseline psychosocial characteristics may be useful to identify women at risk for long-term body image and sexual problems following BRRM, but not among breast cancer patients opting for CRRM.

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“…But the majority of mutation carriers [22,23] and also patients with sporadic breast cancer decide for implant-based immediate reconstruction [24]. This is accompanied by a recent fast development of new materials and techniques to improve long-lasting esthetic results in implant-based and mesh-or acellular dermal matrix (ADM)-supported breast reconstruction.…”

Section: Best Choice For Bilateral Breast Reconstructionmentioning

confidence: 99%

Role of Breast Surgery in BRCA Mutation Carriers

Nestle-Krämling

Kühn

2012

Breast Care

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BRCA mutation carriers have a life-long breast cancer risk between 55 and 85% and a high risk of developing breast cancer at a very young age, depending on the type of mutation. The risk of developing contralateral breast cancer after a first breast cancer is elevated up to 65%, especially in case of BRCA1 mutation and young age at the first breast cancer. Since bilateral prophylactic mastectomy is associated with a risk reduction of 90–95% of developing primary or contralateral breast cancer, this option is a key point within the counseling process for patient information and shared decision-making of mutation carriers. Although the local control after breast-conserving therapy in mutation carriers seems to be comparable to that of sporadic breast cancer patients, individual patient information and counseling should include all alternative procedures of oncologically adequate mastectomy techniques and immediate reconstruction. Excellent cosmetic results, high levels of life quality, and good patient acceptance can be achieved with the recent developments in reconstructive surgery of the breast.

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Bilateral Prophylactic Mastectomy in Swedish Women at High Risk of Breast Cancer

Abstract: Bilateral prophylactic mastectomy is safe and efficacious in reducing future breast cancer in asymptomatic women at high risk. Unanticipated reoperations are common. Given the small number of patients centralization seems justified.

Cited by 53 publications

References 45 publications

The frequency and outcome of breast cancer risk-reducing surgery in finnish BRCA1 and BRCA2 mutation carriers

The frequency and outcome of breast cancer risk-reducing surgery in finnish BRCA1 and BRCA2 mutation carriers

Preoperative psychosocial characteristics may predict body image and sexuality two years after risk-reducing mastectomy: a prospective study

Role of Breast Surgery in BRCA Mutation Carriers

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