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Annals of Surgical Oncology

, Volume 22, Issue 10, pp 3208–3212 | Cite as

Contralateral Prophylactic Mastectomy: Challenging Considerations for the Surgeon

  • Peter Angelos
  • Isabelle Bedrosian
  • David M. Euhus
  • Virginia M. Herrmann
  • Steven J. Katz
  • Andrea Pusic
Breast Oncology

Abstract

The use of both bilateral prophylactic mastectomy and contralateral prophylactic mastectomy (CPM) has increased significantly during the last decade. Various risk models have been developed to identify patients at increased risk for breast cancer. The indications for bilateral prophylactic mastectomy for patients without a diagnosis of breast cancer include high risk from mutation in BRCA or other breast cancer predisposition gene, very strong family history with no identifiable mutation, and high risk based on breast histology. Additionally, the use of CPM has more than doubled in the last decade, and this increase is noted among all stages of breast cancer, even in patients with ductal carcinoma in situ (stage 0). The risk of contralateral breast cancer often is overestimated by both patients and physicians. Nevertheless, specific risk factors are associated with an increased risk of contralateral breast cancer, including BRCA or other genetic mutation, young age at diagnosis, lobular histology, family history, and prior chest wall irradiation. Although CPM reduces the incidence of contralateral breast cancer, the effect on disease-free survival and, more importantly, overall survival is questionable and underscored by the fact that the reason most patients choose CPM is to achieve “peace of mind.” Newer and effective reconstructive options have made the procedure more attractive. This panel addresses the indications and rationale for bilateral prophylactic mastectomy and CPM, the decision-making process by patients, and ethical considerations. Changes in the physician–patient relationship during the past few decades have altered the approach, and ethical considerations are paramount in addressing these issues.

Keywords

Breast Cancer Overall Survival Contralateral Breast Cancer BRCA Mutation Carrier Contralateral Prophylactic Mastectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Reiner AS, John EM, Brooks JD, et al. Risk of asynchronous contralateral breast cancer in noncarriers of BRCA1 and BRCA2 mutations with a family history of breast cancer: a report from the Women’s Environmental Cancer and Radiation Epidemiology Study. J Clin Oncol. 2013;31:433–9.PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Fisher B, Costantino J, Redmond C, Poisson R, et al. A randomized clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen-receptor-positive tumors. N Engl J Med. 1989;320:479–84.CrossRefPubMedGoogle Scholar
  3. 3.
    Metcalfe K, Gershman S, Lynch, HT. Predictors of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. Br J Cancer. 2011;104:1384–92.PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Forbes JF, Cuzick J, Buzdar A, Howell A, Tobias JS, Baum M. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol. 2008;9:45–53.CrossRefPubMedGoogle Scholar
  5. 5.
    Nichols HB, Berrington de Gonzalez A, Lacey JV Jr, Rosenberg PS, Anderson WF. Declining incidence of contralateral breast cancer in the United States from 1975 to 2006. J Clin Oncol. 2011;29:1564–9.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Graeser MK, Engel C, Rhiem K. Contralateral breast cancer risk in BRCA1 and BRCA2 mutation carriers. J Clin Oncol. 2009;27:5887–92.CrossRefPubMedGoogle Scholar
  7. 7.
    Bedrosian I, Hu CY, Chang GJ. Population-based study of contralateral prophylactic mastectomy and survival outcomes of breast cancer patients. J Natl Cancer Inst. 2010;102:401–9.PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Brewster AM, Bedrosian I, Parker PA, et al. Association between contralateral prophylactic mastectomy and breast cancer outcomes by hormone receptor status. Cancer. 2012;118:5637–43.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Portschy PR, Kuntz KM, Tuttle TM. Survival outcomes after contralateral prophylactic mastectomy: a decision analysis. J Natl Cancer Inst. 2014;106:1–7.CrossRefGoogle Scholar
  10. 10.
    Herrinton LJ, Barlow WE, Yu O, et al. Efficacy of prophylactic mastectomy in women with unilateral breast cancer: a cancer research network project. J Clin Oncol. 2005;23:4275–86.CrossRefPubMedGoogle Scholar
  11. 11.
    Tuttle TM, Jarosek S, Habermann EB, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol. 2009;27:1362–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Hawley ST, Jagsi R, Morrow M, Janz NK, Hamilton A, Graff JJ, Katz SJ. Social and clinical determinants of contralateral prophylactic mastectomy. JAMA Surg. 2014;149:582–9.CrossRefGoogle Scholar
  13. 13.
    Katz SJ, Morrow M. Contralateral prophylactic mastectomy for breast cancer: addressing peace of mind. JAMA. 2013;310:793–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Hawley ST, Fagerlin A, Janz NK, Katz SJ. Racial/ethnic differences in knowledge about the risks and benefits of breast cancer treatment: does it matter where you go? Health Serv Res. 2008;43:1366–87.PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Katz SJ, Morrow M. Addressing overtreatment in breast cancer: the doctors’ dilemma. Cancer. 2013;119:3584–8.PubMedGoogle Scholar
  16. 16.
    Oken D. What to tell cancer patients: a study of medical attitudes. JAMA. 1961;175:1120–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Novack DH, Plumer R, Smith RL, Ochitill H, Morrow GR, Bennett JM. Changes in physicians’ attitudes toward telling the cancer patient. JAMA. 1979;241:897–900.CrossRefPubMedGoogle Scholar
  18. 18.
    Tung N, Battelli C, Allen B, et al. Frequency of mutations in individuals with breast cancer referred for BRCA1 and BRCA2 testing using next-generation sequencing with a 25-gene panel. Cancer. 2015; 121:25–33. http://www.ncbi.nlm.nih.gov/pubmed/25186627.
  19. 19.
    LaDuca H, Stuenkel AJ, Dolinsky JS, et al. Utilization of multigene panels in hereditary cancer predisposition testing: analysis of more than 2000 patients. Genet Med. 2014;16:830–7. http://www.ncbi.nlm.nih.gov/pubmed/24763289.
  20. 20.
    National Comprehensive Cancer Network. Genetic/familial high-risk assessment: breast and ovarian. In: NCCN clinical practice guidelines in oncology v12015. vol. 1. Fort Washington; 2015.Google Scholar
  21. 21.
    Cybulski C, Wokolorczyk D, Jakubowska A, et al. Risk of breast cancer in women with a CHEK2 mutation with and without a family history of breast cancer. J Clin Oncol. 2011;29:3747–52.CrossRefPubMedGoogle Scholar
  22. 22.
    Goldgar DE, Healey S, Dowty JG, et al. Rare variants in the ATM gene and risk of breast cancer. BCR Breast Cancer Res. 2011;13:R73.CrossRefPubMedGoogle Scholar
  23. 23.
    Bogdanova N, Cybulski C, Bermisheva M, et al. A nonsense mutation (E1978X) in the ATM gene is associated with breast cancer. Breast Cancer Res Treat. 2009;118:207–11. http://www.ncbi.nlm.nih.gov/pubmed/18807267.
  24. 24.
    Hu ES, Pusic AL, Waljee JF, Kuhn L, Hawley ST, Wilkins E, Alderman AK. Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship period. Plast Reconstr Surg. 2009;124:1–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Atisha DM, Rushing CN, Samsa GP, Locklear TD, Cox CE, Shelley Hwang E, Zenn MR, Pusic AL, Abernethy AP. A national snapshot of satisfaction with breast cancer procedures. Ann Surg Oncol. 2015;22:361–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Albornoz CR, Bach PB, Mehrara BJ, Disa JJ, Pusic AL, McCarthy CM, Cordeiro PG, Matros E. A paradigm shift in U.S. breast reconstruction: increasing implant rates. Plast Reconstr Surg. 2013;131:15–23.CrossRefPubMedGoogle Scholar
  27. 27.
    Albornoz CR, Bach PB, Pusic AL, McCarthy CM, Mehrara BJ, Disa JJ, Cordeiro PG, Matros E. The influence of sociodemographic factors and hospital characteristics on the method of breast reconstruction, including microsurgery: a U.S. population-based study. Plast Reconstr Surg. 2012;129:1071–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Han E, Johnson N, Glissmeyer M, Wagie T, Carey B, DelaMelena T, Nelson J. Increasing incidence of bilateral mastectomies: the patient perspective. Am J Surg. 2011;201:615–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Cemal Y, Albornoz CR, Disa JJ, McCarthy CM, Mehrara BJ, Pusic AL, Cordeiro PG, Matros E. A paradigm shift in U.S. breast reconstruction: part 2. The influence of changing mastectomy patterns on reconstructive rate and method. Plast Reconstr Surg. 2013;131:320e–6e.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Peter Angelos
    • 1
  • Isabelle Bedrosian
    • 2
  • David M. Euhus
    • 3
  • Virginia M. Herrmann
    • 4
    • 7
  • Steven J. Katz
    • 5
  • Andrea Pusic
    • 6
  1. 1.McLean Center for Clinical Medical EthicsThe University of ChicagoChicagoUSA
  2. 2.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.The Sidney Kimmel Comprehensive Cancer CenterThe Johns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Division of Surgical Oncology and EndocrinologyWashington University School of MedicineSt. LouisUSA
  5. 5.Departments of Medicine and Health Management and PolicyUniversity of Michigan Medical SchoolAnn ArborUSA
  6. 6.Memorial Sloan Kettering Cancer CenterNew YorkUSA
  7. 7.Washington University School of MedicineSt. LouisUSA

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