Preoperative genetic testing affects surgical decision making in breast cancer patients

Lokich, Elizabeth; Stuckey, Ashley; Raker, Christina; Wilbur, Jennifer Scalia; Laprise, Jessica; Gass, Jennifer

doi:10.1016/j.ygyno.2014.05.028

Cited by 39 publications

(18 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although BRCA1/2 mutation noncarriers generally do not face substantially elevated CBC risk, we observed that 25% of these patients chose to undergo CPM. This figure is substantially lower than that observed among BRCA1/2 mutation carriers in our larger study (88%), and is consistent with a few other studies of CPM in noncarriers following pre-surgical BRCA1/2 testing [11,12,15,17]. However, this level of uptake is somewhat higher than estimates in the general population of women with breast cancer, which suggest that approximately 11%–18% of patients ultimately choose CPM [1–4].…”

Section: Discussionsupporting

confidence: 92%

Psychosocial factors associated with the uptake of contralateral prophylactic mastectomy among BRCA1/2 mutation noncarriers with newly diagnosed breast cancer

Hamilton

Genoff

Salerno

et al. 2017

Breast Cancer Res Treat

View full text Add to dashboard Cite

Purpose Women who are newly diagnosed with breast cancer may consider contralateral prophylactic mastectomy (CPM) to reduce their future risk of cancer in their unaffected breast. Pre-surgical BRCA1/2 genetic testing can provide valuable risk information to guide this choice. However, little is understood about why BRCA1/2 mutation noncarriers, who are generally not at substantially elevated risk of contralateral disease, select CPM. Methods We examined the uptake of CPM among breast cancer patients identified as BRCA1/2 mutation noncarriers (n=92) as part of a larger prospective study of the impact of pre-surgical BRCA1/2 testing. Data obtained from self-report questionnaires and patient medical records were used to examine associations between theoretically-relevant background and psychosocial factors and BRCA1/2 mutation noncarriers’ decisions to undergo CPM. Results Among BRCA1/2 mutation noncarriers, 25% (n=23) elected to undergo CPM. Psychosocial factors including a self-reported physician recommendation for CPM, greater perceived contralateral breast cancer risk, and greater perceived benefits of CPM were all significantly associated with the uptake of CPM. Conclusions A sizeable minority of BRCA1/2 mutation noncarriers choose to undergo CPM after learning their mutation status through pre-surgical genetic testing. BRCA1/2 mutation noncarriers’ cognitive perceptions and social influences appear to be important in shaping their decisions regarding CPM. This work highlights the importance of several psychosocial factors in influencing patients’ surgical decisions. Future research is needed that examines the formation of BRCA1/2 mutation noncarriers’ beliefs regarding their disease and available treatment options, and that characterizes the physician-patient communication that occurs in this complex decision-making context.

show abstract

Section: Discussionsupporting

confidence: 92%

Psychosocial factors associated with the uptake of contralateral prophylactic mastectomy among BRCA1/2 mutation noncarriers with newly diagnosed breast cancer

Hamilton

Genoff

Salerno

et al. 2017

Breast Cancer Res Treat

View full text Add to dashboard Cite

show abstract

“…26,27 TNBC should prompt genetic counseling per National Comprehensive Cancer Network (NCCN) guidelines in patients ≤60 years of age, and genetic testing has also been shown to influence the decision for mastectomy. 28,29 …”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Breast Cancer in 2010–2011 SEER Registries by Hormone and HER2 Receptor Status

et al. 2015

View full text Add to dashboard Cite

Background Although locoregional recurrence is known to affect overall survival for operable breast cancer, the impact of receptor status on locoregional control is debated. Currently, hormone receptor (HR) and human epidermal growth factor receptor-2 (HER2) status are generally not considered relevant to surgical choice. This study examines recent population-level surgical trends with regard to receptor status. Methods We used the Surveillance, Epidemiology, and End Results (SEER) data to identify stage I–III female breast cancers diagnosed from 2010 to 2011. Patients were categorized by HR and HER2 receptor status. Univariate and multivariate logistic regressions were used to assess factors associated with undergoing mastectomy and the choice of contralateral prophylactic mastectomy (CPM). Results The overall mastectomy rate for the 87,504 women diagnosed in 2010–2011 was 43.4 %. On multivariate analysis, the odds of receiving mastectomy was greater for HER2-positive disease with either HR-negative or HR-positive status, than for women with HER2-negative/HR-positive disease (odds ratio 1.73 and 1. 31, respectively; all p values <0.001). Age, stage, marital status, race, and year of diagnosis also correlated with mastectomy. Triple-negative breast cancer (TNBC) was associated with CPM, while HER2 status was not. The mastectomy rate, which increased overall from 2006 to 2010, has continued to increase for stage III disease but has decreased for stage I disease. Mastectomy rates overall were lower in 2011 than 2010 (p = 0.012). Conclusions HER2-positive disease and TNBC were independent predictors of more extensive surgery in this large, recent, population-based cohort. Although mastectomy rates have continued to increase for stage III disease, mastectomy rates overall were lower in 2011 than in previous years.

show abstract

“…7 These women may opt for more aggressive surgical treatment such as bilateral mastectomy. 8,9 For BRCA mutation carriers with a diagnosis of breast cancer who undergo breast-conserving surgery, some studies suggest that the risk of ipsilateral breast cancer is higher than for patients with sporadic breast cancer.…”

mentioning

confidence: 99%

Impact that Timing of Genetic Mutation Diagnosis has on Surgical Decision Making and Outcome for BRCA1/BRCA2 Mutation Carriers with Breast Cancer

et al. 2016

View full text Add to dashboard Cite

Background Deleterious BRCA mutation carriers with breast cancer are at increased risk for additional breast cancer events. This study evaluated the impact that timing of identification of BRCA+ status has on surgical decision and outcome. Methods The authors reviewed all BRCA carriers at their institution whose breast cancer was diagnosed between January 1996 and June 2015. Patient surveys, medical records, and institutional databases were used to collect data. Differences in surgical choice were analyzed using the chi-square test, and rates of subsequent breast cancer events were estimated using the Kaplan–Meier method. Results The study investigated 173 BRCA carriers with breast cancer (100 BRCA1, 73 BRCA2). Of the women with known BRCA mutation before surgery and unilateral stages 0 to 3 breast cancer (n = 63), 12.7 % underwent lumpectomy, 4.8 % underwent unilateral mastectomy (UM), and 82.5 % underwent bilateral mastectomy (BM). These surgical choices differed significantly (p < 0.0001) from those of patients unaware of their mutation at the time of surgery (n = 93) (51.6 % had lumpectomy, 19.4 % had UM, 29 % had BM). Of the patients with BRCA mutation identified after surgery who underwent lumpectomy or UM, 36 (59 %) of 66 underwent delayed BM. The patients with BRCA+ known before diagnosis presented with significantly lower-stage disease (p = 0.02) at diagnosis (69 % stage 0 or 1) than those whose BRCA mutation was identified after cancer diagnosis (40 % stage 0 or 1). Conclusions The study findings showed that BRCA mutation status influences surgical decision. The rates of BM were higher for the patients with BRCA mutation known before surgery. Identification of BRCA mutation after surgery frequently leads to subsequent breast surgery. Genetic testing before surgery is important for patients at elevated risk for BRCA mutation.

show abstract

Preoperative genetic testing affects surgical decision making in breast cancer patients

Cited by 39 publications

References 17 publications

Psychosocial factors associated with the uptake of contralateral prophylactic mastectomy among BRCA1/2 mutation noncarriers with newly diagnosed breast cancer

Psychosocial factors associated with the uptake of contralateral prophylactic mastectomy among BRCA1/2 mutation noncarriers with newly diagnosed breast cancer

Surgical Management of Breast Cancer in 2010–2011 SEER Registries by Hormone and HER2 Receptor Status

Impact that Timing of Genetic Mutation Diagnosis has on Surgical Decision Making and Outcome for BRCA1/BRCA2 Mutation Carriers with Breast Cancer

Contact Info

Product

Resources

About