Predictors of Contralateral Prophylactic Mastectomy and the Impact on Breast Reconstruction

Pinell-White, Ximena; Kolegraff, Keli; Carlson, Grant W.

doi:10.1097/sap.0000000000000099

Cited by 30 publications

(45 citation statements)

References 22 publications

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“…Only a few small, single‐institution studies have explicitly examined the potential association of preoperative breast MRI in CPM use. These studies have shown between a 70% and 82% increase from the approximately 3% CPM rate, with MRI use . We report a lower increase in CPM, but significantly increased among women who receive a MRI.…”

Section: Discussioncontrasting

confidence: 42%

Relationship between preoperative breast MRI and surgical treatment of non‐metastatic breast cancer

Onega

Weiss

Goodrich

et al. 2017

Journal of Surgical Oncology

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Background and Objectives More extensive surgical treatments for early stage breast cancer are increasing. The patterns of preoperative MRI overall and by stage for this trend has not been well established. Methods Using Breast Cancer Surveillance Consortium registry data from 2010 through 2014, we identified women with an incident non-metastatic breast cancer and determined use of preoperative MRI and initial surgical treatment (mastectomy, with or without contralateral prophylactic mastectomy (CPM), reconstruction, and breast conserving surgery +/− radiation). Clinical and sociodemographic covariates were included in multivariable logistic regression models to estimate adjusted odds ratios and 95% confidence intervals. Results Of the 13,097 women, 2,217 (16.9%) had a preoperative MRI. Among the women with MRI, results indicated 32% higher odds of unilateral mastectomy compared to breast conserving surgery and of mastectomy with CPM compared to unilateral mastectomy. Women with preoperative MRI also had 56% higher odds of reconstruction. Conclusion Preoperative MRI in women with DCIS and early stage invasive breast cancer is associated with more frequent mastectomy, CPM, and reconstruction surgical treatment. Use of more extensive surgical treatment and reconstruction among women with DCIS and early stage invasive cancer whom undergo MRI warrants further investigation.

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Section: Discussioncontrasting

confidence: 42%

Relationship between preoperative breast MRI and surgical treatment of non‐metastatic breast cancer

Onega

Weiss

Goodrich

et al. 2017

Journal of Surgical Oncology

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“…In a survey of over 200 CPM patients, Soran et al showed that in addition to concerns for development of contralateral breast cancer, the availability of reconstruction was cited as a reason for undergoing CPM 9 . The possible link between decisions to undergo CPM and decisions for breast reconstruction are alluded to in a retrospective study of 446 mastectomy patients including 174 CPM patients performed by Pinell-White et al, which showed that women who underwent CPM were more likely to pursue breast reconstruction 10 .…”

Section: Discussionmentioning

confidence: 99%

“…The availability of reconstruction was cited as a factor in favor of deciding to undergo CPM in a recent survey of 200 patients 9 . A separate retrospective study also showed that women who undergo CPM are more likely to pursue breast reconstruction 10 . The role of varying reconstructive strategies on decisions made for CPM is yet to be evaluated.…”

Section: Introductionmentioning

confidence: 95%

Defining the Relationship between Patient Decisions to Undergo Breast Reconstruction and Contralateral Prophylactic Mastectomy

Agarwal

Kidwell

Kraft

et al. 2015

Plastic and Reconstructive Surgery

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BACKGROUND Recent studies suggest that the decision to undergo breast reconstruction and contralateral prophylactic mastectomy (CPM) are closely related. Here we describe the relationship between method of reconstruction and decision to undergo CPM. We also evaluate recent trends in CPM use in the context of literature questioning its oncologic benefit. STUDY DESIGN Female patients with unilateral breast cancer were identified and data extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 through 2010. Logistic regression analyses were performed to study the relationship between having CPM and key demographic, oncologic and reconstructive factors among women with unilateral breast cancer. RESULTS A total of 157,042 patients with unilateral breast cancer were included. CPM rate increased from 7.7% to 28.3% during the study period, and the proportion of reconstructed patients who underwent CPM increased from 19% to 46%. Reconstruction was associated with higher odds of CPM (odds ratio (OR) 2.79, 95% CI 2.70-2.88, p<0.0001) after controlling for oncologic and demographic factors. Among women who had reconstruction, implant-based reconstruction was associated with significantly higher odds of CPM than autologous tissue reconstruction (OR 1.38, p<0.0001). Over the study period Implant reconstruction rates increased from 28.2% to 43.5% while autologous reconstruction rates decreased from 32.2% to 27.3% in CPM patients. CONCLUSIONS The frequency of CPM continues to increase in spite of literature questioning its oncologic benefit. Our study confirms that reconstruction and the decision to undergo CPM are closely related, with implant reconstruction dominating in patients who undergo CPM. Given the relationship between reconstruction and the choice for CPM, plastic surgeons should play an active role in educating patients to avoid decisions made based on inaccurate information.

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“…28e31 The majority of our cohort (w80%) sought reconstructive surgery and the most complex autologous procedures were also the most popular. Breast reconstruction adds substantially to the morbidity 28 and complications commonly affect the prophylactic side in bilateral mastectomy. 31,32 Whilst in the main, patients selecting CPM are satisfied, a proportion of patients will experience regret, issues with body image, challenges forming sexual relationships and lack feelings of femininity.…”

Section: Discussionmentioning

confidence: 99%

A multidisciplinary team approach minimises prophylactic mastectomy rates

Leff

Thomas

et al. 2015

European Journal of Surgical Oncology (EJSO)

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Predictors of Contralateral Prophylactic Mastectomy and the Impact on Breast Reconstruction

Abstract: The incidence of CPM is increasing and is associated with younger age, white race, family history, and the use of breast reconstruction. Implant-based reconstructions predominate in this cohort. The added morbidity of a contralateral procedure is significant.

Cited by 30 publications

References 22 publications

Relationship between preoperative breast MRI and surgical treatment of non‐metastatic breast cancer

Relationship between preoperative breast MRI and surgical treatment of non‐metastatic breast cancer

Defining the Relationship between Patient Decisions to Undergo Breast Reconstruction and Contralateral Prophylactic Mastectomy

A multidisciplinary team approach minimises prophylactic mastectomy rates

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