Predictors of uptake of contralateral prophylactic mastectomy in women with nonhereditary breast cancer

Abstract

Background The rates of contralateral prophylactic mastectomy (CPM) are increasing in women with breast cancer. Previous retrospective research has examined clinical and demographic predictors of the uptake of CPM. However, to the authors' knowledge, there has been very little prospective research to date that has examined psychosocial functioning prior to breast cancer surgery to determine whether psychosocial functioning predicts uptake of CPM. The current study was conducted to evaluate demographic, clinical, and psychosocial predictors of the uptake of CPM in women with unilateral breast cancer without a BRCA1 or BRCA2 mutation. Methods Women with unilateral non–BRCA‐associated breast cancer completed questionnaires prior to undergoing breast cancer surgery. Participants completed demographic and psychosocial questionnaires assessing anxiety, depression, cancer‐related distress, optimism/pessimism, breast satisfaction, and quality of life. Pathological and surgical data were collected from medical charts. Results A total of 506 women consented to participate, 112 of whom (22.1%) elected to undergo CPM. Age was found to be a significant predictor of CPM, with younger women found to be significantly more likely to undergo CPM compared with older women (P < .0001). The rate of CPM was significantly higher in women with noninvasive breast cancer compared with those with invasive breast cancer (P < .0001). Women who elected to undergo CPM had lower levels of presurgical breast satisfaction (P = .01) and optimism (P = .05) compared with women who did not undergo CPM. Conclusions Psychosocial functioning at the time of breast cancer surgery decision making impacts decisions related to CPM. Women who have lower levels of breast satisfaction (body image) and optimism are more likely to elect to undergo CPM. It is important for health care providers to take psychosocial functioning into consideration when discussing surgical options.

Timely Cancer Genetic Counseling and Testing for Young Women With Breast Cancer: Impact on Surgical Decision-making for Contralateral Risk-reducing Mastectomy

“…[14][15][16][17][18] Consequently, earlier age at diagnosis and family history of BC/OC have been shown to be positively correlated with the decision to have CRRM in women with BC, regardless of genetic testing outcome. [19,37,38,46,[60][61][62] In this study, we did not observe any association between age at diagnosis and surgical decision when adjusted for GT result. However, all patients included in this study were 45 years old or younger, which hindered the ability to evaluate the impact of age at diagnosis on surgical decision making.…”

“…Although higher CRRM rates with early-stage disease have previously been reported, disease stage was not shown to be associated with CRRM in our study. [19,37,61] Although cancer GT can provide valuable information in risk assessment and promote risk-appropriate management, some test results have the potential to lead to unnecessary interventions. Variants of uncertain significance (VUSs) in cancer predisposition genes do not have any clinical implications, and should not be used in risk assessment or risk management considerations.…”

Contralateral prophylactic mastectomy: A narrative review of the evidence and acceptability

“…A study [53] which used the Markov model to simulate survival outcomes in non-BRCA carriers after CPM and no CPM, found a less than 1% 20-year overall survival benefit after CPM. Other studies found between 45% and 48% improved 15 to 20-years survival rates in patients with BRCA1/2 mutations who got CPM compared to patients who got unilateral mastectomy or breast conserving surgery [51,59].…”

Early Detection and Dynamic Changes of Circulating Tumor Cells in Transgenic NeuN Transgenic (NTTg) Mice with Spontaneous Breast Tumor Development

“…Others situations, such as young patients, minor genetic mutations (CHEK2, TP53, ATM, PALB2, PTEN, CDH1), or family history without known gene mutation, have shown no evidence of any benefits of prophylaxis mastectomy [54]. Nevertheless, prophylaxis mastectomy is still being used with increasing preference in non-BRCA patients due to low breast satisfaction levels, fear of recurrence, and cosmetic symmetry [55,56]. A recent study reported that PIK3CA hotspot mutations were detected in 37/56 (66.1%) and 23/27 (85.2%) of DNA samples isolated from CellSearch ® cartridges in early and metastatic breast cancer, respectively [57].…”