Contralateral risk-reducing mastectomy in sporadic breast cancer

Murphy, John A.; Milner, Thomas D.; O’Donoghue, J.M.

doi:10.1016/s1470-2045(13)70047-0

Cited by 41 publications

(37 citation statements)

References 69 publications

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“…The fall in CBC risk is most likely due to increasing use of effective adjuvant therapies such as tamoxifen and aromatase inhibitors for treating primary BC [8–10], which also have a protective effect on the contralateral breast. Historically, the CBC rate has been quoted to be 0.5% to 0.75% per year but these estimates are considered outdated with some recent population-based studies estimating it to be 0.1% to 0.3% per year for most women [11–17]. In fact, for the majority of patients affected with first primary BC, their CBC risk is much smaller than the risk of recurrence from their index cancer [3].…”

Section: Introductionmentioning

confidence: 99%

A model for individualized risk prediction of contralateral breast cancer

Chowdhury¹,

Euhus

Onega

et al. 2016

Breast Cancer Res Treat

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Purpose Patients diagnosed with invasive breast cancer (BC) or ductal carcinoma in situ are increasingly choosing to undergo contralateral prophylactic mastectomy (CPM) to reduce their risk of contralateral breast cancer (CBC). This is a particularly disturbing trend as a large proportion of these CPMs are believed to be medically unnecessary. Many BC patients tend to substantially overestimate their CBC risk. Thus, there is a pressing need to educate patients effectively on their CBC risk. We develop a CBC risk prediction model to aid physicians in this task. Methods We used data from two sources: Breast Cancer Surveillance Consortium and Surveillance, Epidemiology, and End Results to build the model. The model building steps are similar to those used in developing the Breast Cancer Risk Assessment Tool (popularly known as Gail model) for counseling women on their BC risk. Our model, named Contralateral Breast Cancer Risk (CBCRisk) is exclusively designed for counseling women diagnosed with unilateral BC on the risk of developing CBC. Results We identified eight factors to be significantly associated with CBC–age at first BC diagnosis, anti-estrogen therapy, family history of BC, high risk pre-neoplasia, estrogen receptor status, breast density, type of first BC, and age at first birth. Combining the relative risk estimates with the relevant hazard rates, CBCRisk projects absolute risk of developing CBC over a given period. Conclusions By providing individualized CBC risk, CBCRisk may help in counseling of BC patients. In turn, this may potentially help alleviate the rate of medically unnecessary CPMs.

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Section: Introductionmentioning

confidence: 99%

A model for individualized risk prediction of contralateral breast cancer

Chowdhury¹,

Euhus

Onega

et al. 2016

Breast Cancer Res Treat

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“…1,3,5–7 Whereas CPM substantially reduces the risk of developing a contralateral breast cancer (CBC), most women (e.g., non-BRCA mutation carriers) with unilateral cancer have a relatively low risk of subsequently developing a CBC following their initial diagnosis. 8,9 Furthermore, the risk of CBC in survivors has decreased in recent years, a reduction largely attributed to adjuvant treatment and there is insufficient evidence of any survival advantage conferred by CPM in most women with early-stage breast cancer, especially among those without a documented gene mutation. 10–12 Many women who opt for CPM subsequently choose to have reconstructive surgery, resulting in a longer recovery time, increased surgical complications, and the potential for multiple surgical procedures, possibly delaying the time to initiation of adjuvant systemic therapy.…”

mentioning

confidence: 99%

Local Therapy Decision-Making and Contralateral Prophylactic Mastectomy in Young Women with Early-Stage Breast Cancer

et al. 2015

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Background Rates of contralateral prophylactic mastectomy (CPM) have increased in the United States, with younger women with breast cancer the most likely to have CPM. Methods As part of an ongoing cohort study of young women diagnosed with breast cancer at age ≤40 years, we conducted multinomial logistic regression of data from 560 women with unilateral Stage I-III disease to identify factors associated with: (1) CPM versus unilateral mastectomy (UM); (2) CPM versus breast-conserving surgery (BCS). Results Median age at diagnosis was 37 years; 66 % of women indicated that their doctor said that BCS was an option or was recommended. Of all women, 42.9 % had CPM, 26.8 % UM, and 30.4 % BCS. Among women who said the surgical decision was patient-driven, 59.9 % had CPM, 22.8 % BCS, and 17.3 % UM. Clinical characteristics associated with CPM versus BCS included HER2 positivity, nodal involvement, larger tumor size, lower BMI, parity, and testing positive for a BRCA mutation. Emotional and decisional factors associated with CPM versus UM and BCS included anxiety, less fear of recurrence, and reporting a patient-driven decision. Women who reported a physician-driven decision were less likely to have had CPM than both of the other surgeries, whereas higher confidence with the decision was associated with having CPM versus BCS. Conclusions Many young women with early-stage breast cancer are choosing CPM. The association between CPM and emotional and decisional factors suggest that improved communication together with better psychosocial support may improve the decision-making process.

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“…Worldwide, CPM rates are increasing, and several factors may account for this trend 19 . First, there has been greater use of genetic testing, and CPM is often recommended for women who harbor mutations (such as BRCA 1 and BRCA 2) that increase risk for contralateral breast cancer 20 .…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, some patients may overestimate their risk of developing contralateral breast cancer, and experience considerable anxiety over this issue 21, 22 . In this regard, it is somewhat ironic that CPM rates are increasing during a period when contralateral breast cancer rates are decreasing due to better adjuvant systemic therapies 19 . Thirdly, wider use of pre-operative breast MRI has increased the likelihood of detecting potentially suspicious lesions in the opposite breast, and this may prompt CPM 23 .…”

Section: Discussionmentioning

confidence: 99%

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Contralateral prophylactic mastectomy and its association with reduced mortality: evidence for selection bias

Jatoi

Parsons

2014

Breast Cancer Res Treat

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Background Contralateral prophylactic mastectomy (CPM) refers to removal of the opposite uninvolved breast in women with unilateral breast cancer, and rates are increasing worldwide. In observational studies, CPM is often associated with reductions in breast cancer-specific and all-cause mortality, but this may reflect the selection of a healthier cohort of women for CPM (selection bias). To further explore this possibility, we examined the association between CPM and non-cancer mortality, an indicator of selection bias. Methods We identified 449,178 adult women diagnosed with unilateral, primary American Joint Committee on Cancer (AJCC) stage I–III ductal or lobular breast cancer, utilizing the 1998–2010 Surveillance, Epidemiology, and End Results (SEER) dataset. Of these, 5.8% (n=25,961) underwent CPM as their first course of treatment. We examined associations between CPM and breast cancer-specific, all-cause, and non-cancer mortality utilizing multivariate logistic regression, adjusting for age, race, AJCC stage, estrogen receptor status, progesterone receptor status, and histologic grade of the tumor. Results Among all patients receiving CPM as first course of treatment, CPM was associated with lower breast cancer-specific (HR: 0.84 (95% CI: 0.79–0.89)), all-cause (HR: 0.83 (95% CI: 0.80–0.88)), and non-cancer (HR: 0.71 (95% CI: 0.64–0.80)) 5-year hazard of death. Conclusion Although our results are consistent with other observational studies showing associations between CPM and reductions in breast cancer-specific and all-cause mortality, we demonstrate an even stronger association between CPM and reduced non-cancer mortality. Thus, the reported associations between CPM and reductions in mortality might at least partly be attributable to selection bias.

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Contralateral risk-reducing mastectomy in sporadic breast cancer

Cited by 41 publications

References 69 publications

A model for individualized risk prediction of contralateral breast cancer

A model for individualized risk prediction of contralateral breast cancer

Local Therapy Decision-Making and Contralateral Prophylactic Mastectomy in Young Women with Early-Stage Breast Cancer

Contralateral prophylactic mastectomy and its association with reduced mortality: evidence for selection bias

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