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Preoperative Risk Assessment Among Women Undergoing Bilateral Prophylactic Mastectomy for Cancer Risk Reduction

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Cancer risk assessment is an important decision-making tool for women considering irreversible risk-reducing surgery. Our objective was to determine the prevalence of BRCA testing among women undergoing bilateral prophylactic mastectomy (BPM) and to review the characteristics of women who choose BPM within a metropolitan setting.

Methods

We retrospectively reviewed records of women who underwent BPM in the absence of cancer within 2 health care systems that included 5 metropolitan hospitals. Women with invasive carcinoma or ductal carcinoma in situ (DCIS) were excluded; neither lobular carcinoma in situ (LCIS) nor atypical hyperplasia (AH) were exclusion criteria. We collected demographic information and preoperative screening and risk assessment, BRCA testing, reconstruction, and associated cancer risk-reducing surgery data. We compared women who underwent BRCA testing to those not tested.

Results

From January 2002 to July 2009, a total of 71 BPMs were performed. Only 25 women (35.2%) had preoperative BRCA testing; 88% had a BRCA mutation. Compared with tested women, BRCA nontested women were significantly older (39.1 vs. 49.2 years, P < 0.001), had significantly more preoperative biopsies and mammograms and had fewer previous or simultaneous cancer risk-reducing surgery (oophorectomy). Among BRCA nontested women, common indications for BPM were family history of breast cancer (n = 21, 45.6%) or LCIS or AH (n = 16, 34.8%); 9 nontested women (19.6%) chose BPM based on exclusively on cancer-risk anxiety or personal preference.

Conclusion

Most women who underwent BPM did not receive preoperative genetic testing. Further studies are needed to corroborate our findings in other geographic regions and practice settings.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, University of Minnesota, Minneapolis, MN, USA

    Natasha M. Rueth MD, Amanda K. Arrington MD & Todd M. Tuttle MD

  2. Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, MN, USA

    Melissa McMahon BS

  3. Park Nicollet Health Services, Minneapolis, MN, USA

    Karen Swenson RN, PhD & Joseph Leach MD

Authors
  1. Natasha M. Rueth MD
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  2. Melissa McMahon BS
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  3. Amanda K. Arrington MD
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  4. Karen Swenson RN, PhD
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  5. Joseph Leach MD
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  6. Todd M. Tuttle MD
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Corresponding author

Correspondence to Todd M. Tuttle MD.

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Rueth, N.M., McMahon, M., Arrington, A.K. et al. Preoperative Risk Assessment Among Women Undergoing Bilateral Prophylactic Mastectomy for Cancer Risk Reduction. Ann Surg Oncol 18, 2515–2520 (2011). https://doi.org/10.1245/s10434-011-1642-2

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  • DOI: https://doi.org/10.1245/s10434-011-1642-2

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