Factors Affecting the Decision of Breast Cancer Patients to Undergo Contralateral Prophylactic Mastectomy

Yi, Min; Hunt, Kelly K.; Arun, Banu K.; Bedrosian, Isabelle; Barrera, Angelica M. Gutierrez; Anh, Kim; Kuerer, Henry Mark; Babiera, Gildy; Mittendorf, Elizabeth A.; Ready, Kaylene; Litton, Jennifer K.; Meric‐Bernstam, Funda

doi:10.1158/1940-6207.capr-09-0130

Cited by 138 publications

(112 citation statements)

References 34 publications

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“…We recently reported that only 1.3% of patients treated at our institution between 2000 and 2006 underwent genetic testing before surgery; thus, genetic testing is unlikely to have influenced the choice of treatment in this study period. 34 In our previous work genetic testing was associated with utilization of contralateral prophylactic mastectomy, suggesting that increased utilization of genetic testing could potentially impact prevention of future primary lesions. We also recently reported that up to 20% of patients with TNBC have a BRCA mutation; thus, we expect that TNBC patients will increasingly be referred for genetic testing.…”

Section: Discussionmentioning

confidence: 95%

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Triple-Negative Breast Cancer Is Not a Contraindication for Breast Conservation

et al. 2011

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Background Triple-negative breast cancer (TNBC) is an aggressive subtype shown to have a high risk of locoregional recurrence (LRR). The purpose of this study was to determine the impact of operation type on LRR in TNBC patients. Methods A total of 1325 patients with TNBC who underwent breast-conserving therapy (BCT) or mastectomy from 1980 to the present were identified. Clinical and pathological factors were compared by the chi-square test. LRR-free survival (LRRFS), distant metastasis-free survival, and overall survival were estimated by the Kaplan–Meier method. Multivariate analysis was performed by the Cox proportional hazard models. Results BCT was performed in 651 patients (49%) and mastectomy in 674 (51%). The mastectomy group had larger tumors, a higher incidence of lymphovascular invasion, and higher pathologic N stage (all P < 0.001). At 62-month median follow-up, LRR was seen in 170 (26%) in the BCT group and 203 (30%) in the mastectomy group. Five-year LRRFS rates were higher in the BCT group (76% vs. 71%, P = 0.032), as was distant metastasis-free survival (68% vs. 54%, P < 0.0001) and overall survival (74% vs. 63%, P < 0.0001). On multivariate analysis, T stage (hazard ratio [HR] 1.37, P = 0.006), high nuclear grade (HR 1.92, P = 0.002), lymphovascular invasion (HR 1.93, P < 0.0001), close/positive margins (HR 1.89, P < 0.0001), and use of non–anthracycline or taxane-based adjuvant chemotherapy (HR 2.01, P < 0.0001) increased the LRR risk, while age >50 years was protective (HR 0.73, P = 0.007). Operation type (mastectomy vs. BCT, HR 1.07, P = 0.55) was not statistically significant. Conclusions BCT is not associated with increased LRR rates compared to mastectomy. TNBC should not be considered a contraindication for breast conservation.

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Section: Discussionmentioning

confidence: 95%

“…In general, fewer than 10% of breast cancer patients at our institution undergo breast MRI, and this modality is generally reserved for screening in high risk patients (e.g., lifetime breast cancer risk >20%; genetic predisposition such as BRCA1/2 mutation; prior breast irradiation). 34 …”

Section: Discussionmentioning

confidence: 99%

Triple-Negative Breast Cancer Is Not a Contraindication for Breast Conservation

et al. 2011

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“…2,13–18 More recent research has shown that surgeon recommendation against CPM powerfully reduces receipt. But only about a one third of patients who consider CPM report that their surgeon recommended against it and one third reported no substantial discussion with their surgeon about it.…”

Section: Discussionmentioning

confidence: 99%

Surgeon Influence on Variation in Receipt of Contralateral Prophylactic Mastectomy for Women With Breast Cancer

et al. 2018

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Importance Rates of contralateral prophylactic mastectomy (CPM) have markedly increased but we know little about the influence of surgeons on variability of the procedure in the community. Objective To quantify the influence of attending surgeon on rates of CPM and clinician attitudes that explained it. Design and Setting Population-based survey study in Georgia and Los Angeles County. Participants We identified 7810 women with stages 0-II breast cancer treated in 2013–15 through the Surveillance, Epidemiology, and End Results (SEER) registries of Georgia and Los Angeles County. Surveys were sent approximately 2 months after surgery, (70% response rate, n=5080). Surveys were also sent to 488 attending surgeons identified by the patients, of whom 377 responded (77% response rate). Main Outcomes and Measures We conducted multilevel analyses to examine the impact of surgeon influence on variations in patient receipt of CPM using information from patient and surgeon surveys merged to SEER data. Results The patient mean age was 62; 30% had an increased risk of 2nd primary cancer, and 16% received CPM. Half of surgeons (52%) practiced for >20 years and 30% treated >50 new breast cancer patients annually. Attending surgeon explained a large amount (20%) of the variation in CPM controlling for patient factors. The odds of a patient receiving CPM increased almost 3-fold (OR 2.8, 95% CI 2.1,3.4) if she saw a surgeon with a practice approach one standard deviation above a surgeon with the average CPM rate (independent of age, diagnosis date, BRCA status and risk of 2nd primary). One quarter (25%) of the surgeon influence was explained by attending attitudes about initial recommendations for surgery and responses to patient requests for CPM. The estimated rate of CPM was 34% for surgeons who least favored initial breast conservation and were least reluctant to perform CPM vs 4% for surgeons who most favored initial breast conservation and were most reluctant to perform CPM. Conclusion and Relevance Attending surgeons exert strong influence on the likelihood receipt of CPM after diagnosis of breast cancer. Variations in surgeon attitudes about recommendation for surgery and response to patients request for CPM explain a substantial amount of this influence.

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“…1,2 To reduce CBC risk, an increasing number of women with DCIS are electing to undergo contralateral prophylactic mastectomy (CPM). 1, 2,4 …”

Section: Introductionmentioning

confidence: 99%

Predictors that Influence Contralateral Prophylactic Mastectomy Election Among Women with Ductal Carcinoma In Situ Who Were Evaluated for BRCA Genetic Testing

et al. 2014

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Background Patients with ductal carcinoma in situ (DCIS) are at increased risk for developing contralateral breast cancer (CBC). Consequently, more women with DCIS are electing contralateral prophylactic mastectomy (CPM). We evaluated factors associated with CPM in patients with DCIS who underwent genetic counseling for BRCA testing. Methods This retrospective study involved 165 women with DCIS referred for genetic counseling between 2003 and 2011. Patient characteristics were age, marital and educational status, tumor markers, nuclear grade, family history of breast cancer (BC) and ovarian cancer (OC), race, Ashkenazi Jewish ancestry, and BRCA results. Univariate and multivariate logistic regression analyses were used to determine predictive factors associated with CPM election. Results Of 165 patients, 44 (27%) underwent CPM. Patients < 45 years were more likely to elect CPM (P = .0098). A BRCA+ mutation was found in 17 patients (10.3%), and BRCA+ women were more likely to elect CPM than BRCA- or untested women (P = 0.0001). Patients who had a family history of OC (57.7%) were more likely to choose CPM than those with no family history (P = 0.0004). Younger age, BRCA+, and an OC family history remained significant in the multivariate model (P < 0.008). Conclusion The CPM rate among patients with DCIS who undergo genetic counseling is high. Factors associated with increased likelihood of CPM among this group were age, BRCA+, and a family history of OC. Further studies are needed to evaluate patients' perceptions of CBC risk and their role in the likelihood of CPM choice.

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Factors Affecting the Decision of Breast Cancer Patients to Undergo Contralateral Prophylactic Mastectomy

Cited by 138 publications

References 34 publications

Triple-Negative Breast Cancer Is Not a Contraindication for Breast Conservation

Triple-Negative Breast Cancer Is Not a Contraindication for Breast Conservation

Surgeon Influence on Variation in Receipt of Contralateral Prophylactic Mastectomy for Women With Breast Cancer

Predictors that Influence Contralateral Prophylactic Mastectomy Election Among Women with Ductal Carcinoma In Situ Who Were Evaluated for BRCA Genetic Testing

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