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Rate of Contralateral Prophylactic Mastectomy is Influenced by Preoperative MRI Recommendations

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

Abstract

Background

Women with breast cancer increasingly undergo contralateral prophylactic mastectomy (CPM). We evaluated the relationship between preoperative magnetic resonance imaging (MRI) findings and CPM. Other clinicopathologic variables associated with CPM choice and the pathology found in the contralateral breast are also reported.

Methods

Newly diagnosed breast cancer patients were prospectively enrolled in the University of Iowa Breast Molecular Epidemiology Resource. Patients with stages 0–III breast cancer who underwent mastectomy for the index cancer were eligible for this analysis. Univariate logistic regression and a multivariate model were used to identify factors predictive of CPM.

Results

Among 134 patients (mean age 54.9 years), 53 (39.6 %) chose CPM. On univariate analysis, patients undergoing CPM were more likely to have a preoperative breast MRI (64.2 vs. 39.5 %, p = 0.006) and to have follow-up testing recommended for the contralateral breast (28.3 vs. 4.9 %, p = 0.001). Univariate analysis also associated CPM with younger age (p < 0.0001), BRCA testing (p < 0.0001), BRCA mutation (p = 0.034) and reconstruction performed (p = 0.001). Median age of youngest child at diagnosis varied significantly between the CPM (15.9 years) and non-CPM (24.3 years) groups (p = 0.0018). On multivariate analysis, MRI follow-up recommendation, young age, reconstruction and human epidermal growth factor receptor 2 (HER2) positivity of the index cancer were significantly associated with CPM. Of the CPM specimens, one (1.8 %) had ductal carcinoma-in situ, which had not been identified on MRI.

Conclusions

Abnormal findings in the contralateral breast on preoperative MRI, as well as young age, reconstruction and HER2-positive status correlated with CPM choice in this cohort. Occult malignancy was rare.

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Hematology, Oncology and Blood and Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA

    Chang Xia MD, PhD & Alexandra Thomas MD

  2. Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA

    Mary C. Schroeder PhD

  3. Department of Surgery, University of Iowa, Iowa City, IA, USA

    Ronald J. Weigel MD, PhD & Sonia L. Sugg MD

Authors
  1. Chang Xia MD, PhD
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  2. Mary C. Schroeder PhD
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  3. Ronald J. Weigel MD, PhD
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  4. Sonia L. Sugg MD
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  5. Alexandra Thomas MD
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Corresponding author

Correspondence to Alexandra Thomas MD.

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Xia, C., Schroeder, M.C., Weigel, R.J. et al. Rate of Contralateral Prophylactic Mastectomy is Influenced by Preoperative MRI Recommendations. Ann Surg Oncol 21, 4133–4138 (2014). https://doi.org/10.1245/s10434-014-3852-x

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  • DOI: https://doi.org/10.1245/s10434-014-3852-x

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