Effectiveness of Prophylactic Surgeries in<i>BRCA1</i>or<i>BRCA2</i>Mutation Carriers: A Meta-analysis and Systematic Review

Li, Xiao; You, Ran; Wang, Xinwei; Liu, Congxin; Xu, Zicheng; Zhou, Jin; Yu, Bin; Xu, Ting; Cai, Hongzhou; Zou, Qing

doi:10.1158/1078-0432.ccr-15-1465

Cited by 179 publications

(134 citation statements)

References 50 publications

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“…A recent meta-analysis suggests that BPM may decrease the risk of developing breast cancer by >90%. 5,6 However, the irreversible approach of removing both healthy breasts is invasive and carries with it the potential for surgical complications. The long-term consequences for women who choose BPM, with or without reconstruction, may also include significant changes in body image as well as psychosocial, sexual, and physical well-being.…”

Section: Introductionmentioning

confidence: 99%

Impact of Bilateral Prophylactic Mastectomy and Immediate Reconstruction on Health-Related Quality of Life in Women at High Risk for Breast Carcinoma: Results of the Mastectomy Reconstruction Outcomes Consortium Study

et al. 2017

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Background Although bilateral prophylactic mastectomy (BPM) can reduce the risk of breast cancer, the decision to proceed surgically can have significant consequences and requires careful deliberation. To facilitate decision-making for women at high risk for breast carcinoma, the risks and benefits of BPM should be well-elucidated. We sought to determine the effects of BPM and immediate reconstruction on health-related quality of life outcomes among a multisite cohort of women at high risk for breast carcinoma. Methods Patient-reported outcome data were prospectively collected as part of the Mastectomy Reconstruction Outcomes Consortium Study. Data on a subgroup of 204 high-risk women who elected to have BPM and immediate reconstruction were evaluated. Baseline scores were compared with scores at one or two years after reconstruction. Results Satisfaction with breasts and psychosocial well-being were significantly higher at both one and two years (p<0.01). Anxiety was significantly lower at one or two years (p<0.01). However, physical well-being of the chest and upper body was significantly worse at one year (p<0.01). Conclusion Our results highlight the impact of BPM and immediate reconstruction on health-related quality of life outcomes in this setting. BPM and reconstruction can result in significant positive, lasting changes in a woman’s satisfaction with her breasts, as well as her psychosocial well-being. Furthermore, presurgery anxiety was significantly reduced by one year postreconstruction and remained reduced at two years. With this knowledge, women at high risk for breast carcinoma and their providers will be better equipped to make the best individualized treatment decisions.

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Section: Introductionmentioning

confidence: 99%

Impact of Bilateral Prophylactic Mastectomy and Immediate Reconstruction on Health-Related Quality of Life in Women at High Risk for Breast Carcinoma: Results of the Mastectomy Reconstruction Outcomes Consortium Study

et al. 2017

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“…On the other hand, RRM is a very efficacious procedure and can reduce the risk of breast cancer by 89·5–100 per cent, but does not necessarily improve overall survival. For BRCA1 /2 carriers without a previous breast cancer diagnosis, RRSO is associated with an estimated 45 per cent reduction in breast cancer risk and a 65 per cent reduction in all‐cause mortality. Alternatively, endocrine prophylaxis with tamoxifen is associated with breast cancer risk reduction in patients with BRCA2 mutations.…”

Section: Hereditary Breast and Ovarian Cancermentioning

confidence: 99%

Quality-of-life implications of risk-reducing cancer surgery

Altman

Hui

Tuttle

2018

British Journal of Surgery

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Background: Modern advances in genetic sequencing techniques have allowed for increased availability of genetic testing for hereditary cancer syndromes. Consequently, more people are being identified as mutation carriers and becoming aware of their increased risk of malignancy. Testing is commonplace for many inheritable cancer syndromes, and with that comes the knowledge of being a gene carrier for some patients. With increased risk of malignancy, many guidelines recommend that gene carriers partake in risk reduction strategies, including risk-reducing surgery for some syndromes. This review explores the quality-of-life consequences of genetic testing and risk-reducing surgery.Methods: A narrative review of PubMed/MEDLINE was performed, focusing on the health-related quality-of-life implications of surgery for hereditary breast and ovarian cancer, familial adenomatous polyposis and hereditary diffuse gastric cancer.Results: Risk-reducing surgery almost uniformly decreases cancer anxiety and affects patients' quality of life. Conclusion:Although the overwhelming quality-of-life implications of surgery are neutral to positive, risk-reducing surgery is irreversible and can be associated with short-and long-term side-effects.

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“…In contrast, for the subgroup of BRCA1 and BRCA2 mutation carriers, prophylactic bilateral mastectomy has to be discussed as a potential way to significantly reduce the immanent high life-time risk for developing breast cancer [44]. For patients who are already diagnosed with or have been treated for unilateral breast cancer and who were tested positive for a BRCA1 or BRCA2 mutation, a potential benefit of a bilateral mastectomy (if BCT is possible for the affected breast) or a CPM has not been clearly demonstrated so far: As we know, the rate of a second occurrence of ipsilateral metachronic breast cancer is not higher in comparison to non-mutation carriers [45].…”

Section: Paradoxical Trend: Rising Rate Of Mastectomiesmentioning

confidence: 99%

Is Mastectomy Oncologically Safer than Breast-Conserving Treatment in Early Breast Cancer

et al. 2017

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Aim: To describe and discuss the evidence for oncological safety of different procedures in oncological breast surgery, i.e. breast-conserving treatment versus mastectomy. Methods: Literature review and discussion. Results: Oncological safety in breast cancer surgery has many dimensions. Breast-conserving treatment has been established as the standard surgical procedure for primary breast cancer and fits to the preferences of most breast cancer patients concerning oncological safety and aesthetic outcome. Conclusions: Breast-conserving treatment is safe. Nonetheless, the preferences of the individual patients in their consideration of breast conservation versus mastectomy should be integrated into routine treatment decisions.

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Effectiveness of Prophylactic Surgeries inBRCA1orBRCA2Mutation Carriers: A Meta-analysis and Systematic Review

Abstract: BRCA1/2 mutation carriers who have been treated with PS have a substantially reduced breast cancer incidence and mortality. Clin Cancer Res; 22(15); 3971-81. ©2016 AACR.

Cited by 179 publications

References 50 publications

Impact of Bilateral Prophylactic Mastectomy and Immediate Reconstruction on Health-Related Quality of Life in Women at High Risk for Breast Carcinoma: Results of the Mastectomy Reconstruction Outcomes Consortium Study

Impact of Bilateral Prophylactic Mastectomy and Immediate Reconstruction on Health-Related Quality of Life in Women at High Risk for Breast Carcinoma: Results of the Mastectomy Reconstruction Outcomes Consortium Study

Quality-of-life implications of risk-reducing cancer surgery

Is Mastectomy Oncologically Safer than Breast-Conserving Treatment in Early Breast Cancer

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