Predictors that Influence Contralateral Prophylactic Mastectomy Election Among Women with Ductal Carcinoma In Situ Who Were Evaluated for BRCA Genetic Testing
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Patients with ductal carcinoma in situ (DCIS) are at increased risk for developing contralateral breast cancer (CBC). Consequently, more women with DCIS are electing to undergo contralateral prophylactic mastectomy (CPM). We evaluated factors associated with CPM in patients with DCIS who underwent genetic counseling for BRCA testing.
This retrospective study involved 165 women with DCIS referred for genetic counseling between 2003 and 2011. Patient characteristics were age, marital and educational status, tumor markers, nuclear grade, family history of breast cancer (BC) and ovarian cancer (OC), race, Ashkenazi Jewish ancestry, and BRCA results. Univariate and multivariate logistic regression analyses were used to determine predictive factors associated with CPM election.
Of 165 patients, 44 (27 %) underwent CPM. Patients <45 years of age were more likely to elect CPM (p = 0.0098). A BRCA+ mutation was found in 17 patients (10.3 %), and BRCA+ women were more likely to elect CPM than BRCA or untested women (p = 0.0001). Patients who had a family history of OC (57.7 %) were more likely to choose CPM than those with no family history (p = 0.0004). Younger age, BRCA+, and an OC family history remained significant in the multivariate model (p < 0.008).
The CPM rate among patients with DCIS who undergo genetic counseling is high. Factors associated with increased likelihood of CPM among this group were age, BRCA+, and a family history of OC. Further studies are needed to evaluate patients’ perceptions of CBC risk and their role in the likelihood of CPM choice.
- Bayraktar S, Elsayegh N, Gutierrez Barrera A, et al. Predictive factors for BRCA1/BRCA2 mutations in women with ductal carcinoma in situ. Cancer. 2012;118: 515–22.
- Tuttle T, Jarosek S, Habermann E, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol. 2009;27:1362–67. CrossRef
- Kuerer HM, Albarracin CT, Yang WT, et al. Ductal carcinoma in situ: state of the science and roadmap to advance the field. J Clin Oncol. 2009;27:279–88. CrossRef
- Yi M, Hunt K, Arun B, et al. Factors affecting the decision of breast cancer patients to undergo contralateral prophylactic mastectomy. Cancer Prev Res. 2010;3:1026–34. CrossRef
- Ford D, Easton DF, Stratton M, et al. Genetic heterogeneity and penetrance analysis of the BRCA1 and BRCA2 genes in breast cancer families. The Breast Cancer Linkage Consortium. Am J Hum Genet. 1998;62:676–89. CrossRef
- Chen S, Iversen ES, Friebel T, et al. Characterization of BRCA1 and BRCA2 mutations in a large United States sample. J Clin Oncol. 2006;24:863–71. CrossRef
- Rebbeck TR, Friebel T, Lynch HT, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol. 2004;22:1055–62. CrossRef
- Chung A, Huynh K, Lawrence C, Sim MS, Giuliano A. Comparison of patient characteristics and outcomes of contralateral prophylactic mastectomy and unilateral total mastectomy in breast cancer patients. Ann Surg Oncol. 2012;19:2600–06. CrossRef
- Stuckey A, Dizon D, Scalia Wilbur J, et al. Clinical characteristics and choices regarding risk-reducing surgery in BRCA mutation carriers. Gynecol Obstet Invest. 2010;69:270–73. CrossRef
- Wainberg S, Husted J. Utilization of screening and preventive surgery among unaffected carriers of a BRCA1 or BRCA2 gene mutation. Cancer Epidemiol Biomark Prev. 2004;13:1989–95.
- Skytte AB, Gerdes AM, Andersen MK, et al. Risk-reducing mastectomy and salpingo-oophorectomy in unaffected BRCA mutation carriers: uptake and timing. Clin Genet. 2010;77:342–49. CrossRef
- Hwang ES, et al. Ductal carcinoma in situ in BRCA mutation carriers. J Clin Oncol. 2007;25:642–47. CrossRef
- Lakhani SR, Jacquemier J, Sloane JP, et al. Multifactorial analysis of differences between sporadic breast cancers and cancers involving BRCA1 and BRCA2 mutations. J Natl Cancer Inst. 1998;90:1138–45. CrossRef
- Frank TS, Deffenbaugh AM, Reid JE, et al. Clinical characteristics of individuals with germline mutations in BRCA1 and BRCA2: analysis of 10,000 individuals. J Clin Oncol. 2002;20:1480–90. CrossRef
- National Comprehensive Cancer Network. Genetic/familial high-risk assessment: breast and ovarian (version 1.2013). http://www.nccn.org/professionals/physician_gls/pdf/genetics_screening.pdf. Accessed 7 Nov 2013.
- Snedecor GW, Cochran WG. Statistical methods. 7th ed. Ames: The Iowa State University Press; 1980.
- Hosmer DW, Lemeshow S. Applied logistic regression. 2nd ed. New York: Wiley; 2000. CrossRef
- Heemskerk-Gerritsen BA, Brekelmans CT, Menke-Pluymers MB, et al. Prophylactic mastectomy in BRCA1/2 mutation carriers and women at risk of hereditary breast cancer: long-term experiences at the Rotterdam Family Cancer Clinic. Ann Surg Oncol. 2007;14:3335–44. CrossRef
- Litton JK, et al. Perception of screening and risk reduction surgeries in patients tested for a BRCA deleterious mutation. Cancer 2009;115:1598–604. CrossRef
- Meijers-Heijbor H, Van Geel B, Van Putten WL, et al. Breast cancer after prophylactic mastectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med. 2001;345:159–64. CrossRef
- Hartmann LC, Sellers TA, Schaid DJ, et al. Efficacy of bilateral prophylactic mastectomy in BRCA1 and BRCA2 gene mutation carriers. J Natl Cancer Inst. 2001;93:1633–37. CrossRef
- Howard-McNatt M, Schroll RW, Hurt GJ, Levine EA. Contralateral prophylactic mastectomy in breast cancer patients who test negative for BRCA mutations. Am J Surg. 2011;202:298–302. CrossRef
- Goldflam K, Hunt KK, Gershenwald JE, et al. Contralateral prophylactic mastectomy: predictors of significant histologic findings. Cancer. 2004;101:1977–86. CrossRef
- Alvarado R, et al. Biology, treatment, and outcome in very young and old women with DCIS. Ann Surg Oncol. 2012;19:3777–84. CrossRef
- Montgomery LL, Tran KN, Heelan MC, et al. Issues of regret in women with contralateral prophylactic mastectomies. Ann Surg Oncol. 1999;6:546–52. CrossRef
- Predictors that Influence Contralateral Prophylactic Mastectomy Election Among Women with Ductal Carcinoma In Situ Who Were Evaluated for BRCA Genetic Testing
Annals of Surgical Oncology
Volume 21, Issue 11 , pp 3466-3472
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- Springer US
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- 1. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 2. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 4. Department of Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA