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Contralateral Prophylactic Mastectomy for Women with T4 Locally Advanced Breast Cancer

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

Abstract

Background

The use of contralateral prophylactic mastectomy (CPM) for women with unilateral breast cancer is increasing. The authors were interested in assessing whether this trend extended to patients with T4 disease.

Methods

We identified 92 patients from our prospective breast surgery registry with unilateral clinical T4 M0 disease who underwent mastectomy at our institution from October 2008 to July 2015. Patient, tumor, and treatment variables were compared between patients who did and those who did not undergo CPM, and the reasons patients elected CPM were ascertained.

Results

Of the 92 patients, 33 (36 %) underwent a CPM, including 25 of 55 patients (45 %) with inflammatory breast cancer. Immediate breast reconstruction was performed for 11 of the 92 patients (12 %), including 4 CPM patients. Pathology showed benign findings in all 33 CPM cases, including 3 patients with atypical hyperplasia. The primary reason for CPM reported by the patients included fear of occult current or future breast cancer in 12 cases (36 %), symmetry in 11 cases (33 %), avoidance of future chemotherapy in 5 cases (15 %), deleterious BRCA mutation in 2 cases (6 %), contralateral benign breast disease in 2 cases (6 %), and medical oncologist recommendation in 1 cases (3 %). Patients selecting CPM were younger and more likely to have undergone BRCA testing.

Conclusions

A substantial rate of CPM was observed among women undergoing mastectomy for unilateral T4 breast cancer despite the considerable risk of mortality from their index cancer. The reasons for selection of CPM paralleled those reported for patients with early-stage disease. The most common motivation was fear of occult current or future breast cancer and included the desire to avoid further chemotherapy.

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References

  1. Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;25:5203–9.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

  3. Yao K, Stewart AK, Winchester DJ, Winchester DP. Trends in contralateral prophylactic mastectomy for unilateral cancer: a report from the National Cancer Data Base, 1998–2007. Ann Surg Oncol. 2010;17:2554–62.

    Article  PubMed  Google Scholar 

  4. Damle S, Teal CB, Lenert JJ, Marshall EC, Pan Q, McSwain AP. Mastectomy and contralateral prophylactic mastectomy rates: an institutional review. Ann Surg Oncol. 2011;18:1356–63.

    Article  PubMed  Google Scholar 

  5. Morrow M. Prophylactic mastectomy of the contralateral breast. Breast. 2011;20(Suppl 3):S108–10.

    Article  PubMed  Google Scholar 

  6. Habermann EB, Thomsen KM, Hieken TJ, Boughey JC. Impact of availability of immediate breast reconstruction on bilateral mastectomy rates for breast cancer across the United States: data from the nationwide inpatient sample. Ann Surg Oncol. 2014;21:3290–6.

    Article  PubMed  Google Scholar 

  7. Kurian AW, Lichtensztajn DY, Keegan TH, Nelson DO, Clarke CA, Gomez SL. Use of and mortality after bilateral mastectomy compared with other surgical treatments for breast cancer in California, 1998–2011. JAMA. 2014;312:902–14.

    Article  CAS  PubMed  Google Scholar 

  8. Hoskin TL, Hieken TJ, Degnim AC, Jakub JW, Jacobson SR, Boughey JC. Use of immediate breast reconstruction and choice for contralateral prophylactic mastectomy. Surgery. 2016;159:1199–209.

    Article  PubMed  Google Scholar 

  9. Soran A, Kamali Polat A, Johnson R, McGuire KP. Increasing trend of contralateral prophylactic mastectomy: What are the factors behind this phenomenon? Surgeon. 2014;12:316–22.

    Article  PubMed  Google Scholar 

  10. Peralta EA, Ellenhorn JD, Wagman LD, Dagis A, Andersen JS, Chu DZ. Contralateral prophylactic mastectomy improves the outcome of selected patients undergoing mastectomy for breast cancer. Am J Surg. 2000;180:439–45.

    Article  CAS  PubMed  Google Scholar 

  11. McDonnell SK, Schaid DJ, Myers JL, et al. Efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer. J Clin Oncol. 2001;19:3938–43.

    CAS  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. Boughey JC, Hoskin TL, Degnim AC, et al. Contralateral prophylactic mastectomy is associated with a survival advantage in high-risk women with a personal history of breast cancer. Ann Surg Oncol. 2010;17:2702–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Evans DG, Ingham SL, Baildam A, et al. Contralateral mastectomy improves survival in women with BRCA1/2-associated breast cancer. Breast Cancer Res Treat. 2013;140:135–42.

    Article  CAS  PubMed  Google Scholar 

  16. Metcalfe K, Gershman S, Ghadirian P, et al. Contralateral mastectomy and survival after breast cancer in carriers of BRCA1 and BRCA2 mutations: retrospective analysis. BMJ. 2014;348:g226.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Giuliano AE, Boolbol S, Degnim A, Kuerer H, Leitch AM, Morrow M. Society of Surgical Oncology: position statement on prophylactic mastectomy. Approved by the Society of Surgical Oncology Executive Council, March 2007. Ann Surg Oncol. 2007;14:2425–7.

    Article  PubMed  Google Scholar 

  18. Edge S, editor. Breast cancer. In: AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

  19. NCCN clinical practice guidelines in oncology: breast cancer v1. 2016. http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 1 Mar 2016.

  20. Dawood S, Merajver SD, Viens P, et al. International Expert Panel on Inflammatory Breast Cancer: consensus statement for standardized diagnosis and treatment. Ann Oncol. 2011;22:515–23.

    Article  CAS  PubMed  Google Scholar 

  21. Shen J, Valero V, Buchholz TA, et al. Effective local control and long-term survival in patients with T4 locally advanced breast cancer treated with breast conservation therapy. Ann Surg Oncol. 2004;11:854–60.

    Article  PubMed  Google Scholar 

  22. Hance KW, Anderson WF, Devesa SS, Young HA, Levine PH. Trends in inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program at the National Cancer Institute. J Natl Cancer Inst. 2005;97:966–75.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Low JA, Berman AW, Steinberg SM, Danforth DN, Lippman ME, Swain SM. Long-term follow-up for locally advanced and inflammatory breast cancer patients treated with multimodality therapy. J Clin Oncol. 2004;22:4067–74.

    Article  CAS  PubMed  Google Scholar 

  24. Kim HJ, Lee SB, Moon HG, et al. A proposal for a new classification of T4 breast cancer as stage IIIC: a report from the Korean Breast Cancer Society. Breast Cancer Res Treat. 2015;153:153–60.

    Article  PubMed  Google Scholar 

  25. Kummerow KL, Du L, Penson DF, Shyr Y, Hooks MA. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg. 2015;150:9–16.

    Article  PubMed  Google Scholar 

  26. Grimmer L, Liederbach E, Velasco J, Pesce C, Wang CH, Yao K. Variation in contralateral prophylactic mastectomy rates according to racial groups in young women with breast cancer, 1998 to 2011: a report from the National Cancer Data Base. J Am Coll Surg. 2015;221:187–96.

    Article  PubMed  Google Scholar 

  27. King TA, Sakr R, Patil S, et al. Clinical management factors contribute to the decision for contralateral prophylactic mastectomy. J Clin Oncol. 2011;29:2158–64.

    Article  PubMed  Google Scholar 

  28. Jones NB, Wilson J, Kotur L, Stephens J, Farrar WB, Agnese DM. Contralateral prophylactic mastectomy for unilateral breast cancer: an increasing trend at a single institution. Ann Surg Oncol. 2009;16:2691–6.

    Article  PubMed  Google Scholar 

  29. Yi M, Hunt KK, Arun BK, et al. Factors affecting the decision of breast cancer patients to undergo contralateral prophylactic mastectomy. Cancer Prev Res. 2010;3:1026–34.

    Article  Google Scholar 

  30. Guth U, Myrick ME, Viehl CT, Weber WP, Lardi AM, Schmid SM. Increasing rates of contralateral prophylactic mastectomy: a trend made in USA? Eur J Surg Oncol. 2012;38:296–301.

    Article  CAS  PubMed  Google Scholar 

  31. Miller ME, Czechura T, Martz B, et al. Operative risks associated with contralateral prophylactic mastectomy: a single-institution experience. Ann Surg Oncol. 2013;20:4113–20.

    Article  PubMed  Google Scholar 

  32. Fu Y, Zhuang Z, Dewing M, Apple S, Chang H. Predictors for contralateral prophylactic mastectomy in breast cancer patients. Int J Clin Exp Pathol. 2015;8:3748–64.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Stucky CC, Gray RJ, Wasif N, Dueck AC, Pockaj BA. Increase in contralateral prophylactic mastectomy: echoes of a bygone era? Surgical trends for unilateral breast cancer. Ann Surg Oncol. 2010;17(Suppl 3):330–7.

    Article  PubMed  Google Scholar 

  34. Sorbero ME, Dick AW, Beckjord EB, Ahrendt G. Diagnostic breast magnetic resonance imaging and contralateral prophylactic mastectomy. Ann Surg Oncol. 2009;16:1597–605.

    Article  PubMed  Google Scholar 

  35. 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;19:2600–6.

    Article  PubMed  Google Scholar 

  36. Arrington AK, Jarosek SL, Virnig BA, Habermann EB, Tuttle TM. Patient and surgeon characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer. Ann Surg Oncol. 2009;16:2697–704.

    Article  PubMed  Google Scholar 

  37. Montgomery LL, Tran KN, Heelan MC, et al. Issues of regret in women with contralateral prophylactic mastectomies. Ann Surg Oncol. 1999;6:546–52.

    Article  CAS  PubMed  Google Scholar 

  38. Han E, Johnson N, Glissmeyer M, et al. Increasing incidence of bilateral mastectomies: the patient perspective. Am J Surg. 2011;201:615–8.

    Article  PubMed  Google Scholar 

  39. Soran A, Ibrahim A, Kanbour M, et al. Decision making and factors influencing long-term satisfaction with prophylactic mastectomy in women with breast cancer. Am J Clin Oncol. 2015;38:179–83.

    Article  PubMed  Google Scholar 

  40. Erdahl LM, Boughey JC, Hoskin TL, Degnim AC, Hieken TJ. Contralateral prophylactic mastectomy: factors predictive of occult malignancy or high-risk lesion and the impact of MRI and genetic testing. Ann Surg Oncol. 2016;23:72–7.

    Article  PubMed  Google Scholar 

  41. Burke EE, Portschy PR, Tuttle TM. Contralateral prophylactic mastectomy: Are we overtreating patients? Expert Rev Anticancer Ther. 2014;14:491–4.

    Article  CAS  PubMed  Google Scholar 

  42. Rosenberg SM, Tracy MS, Meyer ME, et al. Perceptions, knowledge, and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer: a cross-sectional survey. Ann Intern Med. 2013;159:373–81.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Katz SJ, Morrow M. Contralateral prophylactic mastectomy for breast cancer: addressing peace of mind. JAMA. 2013;310:793–4.

    Article  CAS  PubMed  Google Scholar 

  44. Rendle KA, Halley MC, May SG, Frosch DL. Redefining risk and benefit: understanding the decision to undergo contralateral prophylactic mastectomy. Qual Health Res. 2015;25:1251–9.

    Article  PubMed  Google Scholar 

  45. Musiello T, Bornhammar E, Saunders C. Breast surgeons’ perceptions and attitudes towards contralateral prophylactic mastectomy. ANZ J Surg. 2013;83:527–32.

    Article  PubMed  Google Scholar 

  46. Gershenwald JE, Hunt KK, Kroll SS, et al. Synchronous elective contralateral mastectomy and immediate bilateral breast reconstruction in women with early-stage breast cancer. Ann Surg Oncol. 1998;5:529–38.

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest

There are no conflicts of interest.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Brittany L. Murphy MD, Judy C. Boughey MD, Amy C. Degnim MD & Tina J. Hieken MD

  2. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Tanya L. Hoskin MS

  3. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Katrina N. Glazebrook MBChB

Authors
  1. Brittany L. Murphy MD
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  2. Tanya L. Hoskin MS
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  3. Judy C. Boughey MD
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  4. Amy C. Degnim MD
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  5. Katrina N. Glazebrook MBChB
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  6. Tina J. Hieken MD
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Corresponding author

Correspondence to Tina J. Hieken MD.

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Murphy, B.L., Hoskin, T.L., Boughey, J.C. et al. Contralateral Prophylactic Mastectomy for Women with T4 Locally Advanced Breast Cancer. Ann Surg Oncol 23, 3365–3370 (2016). https://doi.org/10.1245/s10434-016-5367-0

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  • DOI: https://doi.org/10.1245/s10434-016-5367-0

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