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Breast Cancer Research and Treatment

, Volume 174, Issue 1, pp 39–45 | Cite as

Trends in use of bilateral prophylactic mastectomy vs high-risk surveillance in unaffected carriers of inherited breast cancer syndromes in the Inherited Cancer Registry (ICARE)

  • Danielle A. HenryEmail author
  • Marie C. Lee
  • Deanna Almanza
  • Kamran A. Ahmed
  • Weihong Sun
  • David C. Boulware
  • Christine Laronga
Review
  • 202 Downloads

Abstract

Purpose

Awareness of inherited breast cancer has increased bilateral prophylactic mastectomy (BPM) among unaffected genetic mutation carriers, yet many still choose surveillance. We aimed to identify differences among women electing BPM vs high-risk surveillance.

Methods

Participants from an IRB-approved database recruited from 11/2000 to 01/2017 with a deleterious/pathogenic, variant suspected deleterious, or likely pathogenic mutation in ≥ 1 of 11 genes with increased risk for breast cancer (per 2017 NCCN guidelines) were identified. Participants with breast cancer and males were excluded. Sociodemographic and clinical data were collected. The BPM and high-risk surveillance groups were compared using Wilcoxon, Fisher’s Exact, and Pearson’s Chi-Square analyses.

Results

A total of 304 unaffected genetic mutation carriers were identified; 22 men were excluded. 113/282 (40%) underwent BPM. There was no significant difference in age, race, marital status, high school graduates, family history of breast cancer, breast biopsies, chemoprevention use, or understanding implications of genetic mutation carriage. BPM participants were more likely to have a prior pregnancy (p = 0.0005), college education (p = 0.04), income > $50,000/year (p = 0.01), first-degree relative with breast cancer (p = 0.04), higher total number of relatives with breast cancer (p = 0.01), and rate of risk-reducing salpingo-oophorectomy (p = < 0.0001). The high-risk surveillance group was more likely to have a history of ovarian cancer (p = 0.009) and cancer worry (p = < 0.0001).

Conclusions

BPM is a common but not universal choice among unaffected genetic carriers of inherited breast cancer syndromes. Parity, education, income, ovarian cancer history, first-degree relatives with breast cancer, and cancer worry play significant roles in these decisions.

Keywords

Prophylactic mastectomy High-risk surveillance Genetics Inherited cancer Bilateral mastectomy Family history 

Notes

Compliance with ethical standards

Conflict of interest

Dr. C. Laronga is on the Speaker’s Bureau at Genomic Health and receives royalties from Up-To-Date. Drs. D. Henry, M. Lee, K. Ahmed and W. Sun, Mr. Boulware, and Ms. Almanza have no disclosures.

Ethical approval

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    PDQ Adult Treatment Editorial Board (2018) PDQ® Breast Cancer Treatment. http://www.ncbi.nlm.nih.gov/pubmed/26389406. Accessed 14 Apr 2018
  2. 2.
    American Cancer Society (2018) Cancer Facts & Figs. 2018.  https://doi.org/10.3322/caac.21442
  3. 3.
    Powers B, Pal T, Laronga C (2018) Considerations in testing for inherited breast cancer predisposition in the era of personalized medicine. Surg Oncol Clin N Am 27:1–22.  https://doi.org/10.1016/j.soc.2017.08.003 CrossRefGoogle Scholar
  4. 4.
    Genetic/Familial High-Risk Assessment (2018): Breast and Ovarian. In: NCCN Clin. Pract. Guidel. Oncol. https://www.nccn.org/professionals/physician_gls/pdf/genetics_screening.pdf. Accessed 3 Feb 2018
  5. 5.
    Ponder B (1997) Genetic testing for cancer risk. Science 278:1050–1054.  https://doi.org/10.1126/SCIENCE.278.5340.1050 CrossRefGoogle Scholar
  6. 6.
    PDQ® Cancer Genetics Editorial Board PDQ Genetics of Breast and Gynecologic Cancers (2018): Health Professional Version. In: Bethesda, MD Natl. Cancer Institute. https://www.cancer.gov/types/breast/hp/breast-ovarian-genetics-pdq. Accessed 3 Feb 2018
  7. 7.
    American Cancer Society (2017) Breast Cancer Facts & Figs. 2017–2018Google Scholar
  8. 8.
    Ford D, Easton DF, Stratton M, Narod S, Goldgar D, Devilee P, Bishop DT, Weber B, Lenoir G, Chang-Claude J, Sobol H, Teare MD, Struewing J, Arason A, Scherneck S, Peto J, Rebbeck TR, Tonin P, Neuhausen S, Barkardottir R, Eyfjord J, Lynch H, Ponder BA, Gayther SA, Zelada-Hedman M (1998) Genetic heterogeneity and penetrance analysis of the BRCA1 and BRCA2 genes in breast cancer families. The Breast Cancer Linkage Consortium. Am J Hum Genet 62:676–689CrossRefGoogle Scholar
  9. 9.
    American Society of Clinical Oncology (1996) Statement of the American Society of Clinical Oncology: genetic testing for cancer susceptibility. J Clin Oncol 14:1730–1736CrossRefGoogle Scholar
  10. 10.
    Supreme Court of the United States (2013) Association for molecular pathology et al. v. Myriad Genetics, Inc. https://www.supremecourt.gov/opinions/12pdf/12-398_1b7d.pdf. Accessed 20 Apr 2018
  11. 11.
    Rebbeck TR, Friebel T, Lynch HT, Neuhausen SL, Van’t Veer L, Garber JE, Evans GR, Narod SA, Isaacs C, Matloff E, Daly MB, Olopade OI, Weber BL (2004) Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: The PROSE study group. J Clin Oncol 22:1055–1062.  https://doi.org/10.1200/JCO.2004.04.188 CrossRefGoogle Scholar
  12. 12.
    Padamsee TJ, Wills CE, Yee LD, Paskett ED (2017) Decision making for breast cancer prevention among women at elevated risk. Breast Cancer Res.  https://doi.org/10.1186/s13058-017-0826-5 Google Scholar
  13. 13.
    Domchek SM, Friebel TM, Singer CF, Evans DG, Henry T, Isaacs C, Garber JE, Neuhausen SL, Matloff E (2010) Europe PMC Funders Group Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA 304:967–975.  https://doi.org/10.1001/jama.2010.1237 CrossRefGoogle Scholar
  14. 14.
    Heemskerk-Gerritsen BAM, Menke-Pluijmers MBE, Jager A, Tilanus-Linthorst MMA, Koppert LB, Obdeijn IMA, van Deurzen CHM, Collee JM, Seynaeve C, Hooning MJ (2013) Substantial breast cancer risk reduction and potential survival benefit after bilateral mastectomy when compared with surveillance in healthy BRCA1 and BRCA2 mutation carriers: a prospective analysis. Ann Oncol 24:2029–2035.  https://doi.org/10.1093/annonc/mdt134 CrossRefGoogle Scholar
  15. 15.
    Ne C, Lostumbo L, Wallace J, Ko H, Carbine NE, Lostumbo L, Wallace J, Ko H (2018) Risk-reducing mastectomy for the prevention of primary breast cancer. Cochrane Database Syst Rev doi.  https://doi.org/10.1002/14651858.CD002748.pub4 Google Scholar
  16. 16.
    Hartmann LC, Schaid DJ, Woods JE, Crotty TP, Myers JL, Arnold PG, Petty PM, Sellers TA, Johnson JL, McDonnell SK, Frost MH, Grant CS, Michels VV, Jenkins RB (1999) Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med 340:77–84.  https://doi.org/10.1056/NEJM199901143400201 CrossRefGoogle Scholar
  17. 17.
    Ingham SL, Sperrin M, Baildam A, Ross GL, Clayton R, Lalloo F, Buchan I, Howell A, Evans DGR (2013) Risk-reducing surgery increases survival in BRCA1/2 mutation carriers unaffected at time of family referral. Breast Cancer Res Treat 142:611–618.  https://doi.org/10.1007/s10549-013-2765-x CrossRefGoogle Scholar
  18. 18.
    Euhus D (2014) Genetic testing today. Ann Surg Oncol 21:3209–3215.  https://doi.org/10.1245/s10434-014-3906-0 CrossRefGoogle Scholar
  19. 19.
    Saslow D, Boetes C, Burke W, Harms S, Leach MO, Lehman CD, Morris E, Pisano E, Schnall M, Sener S, Smith RA, Warner E, Yaffe M, Andrews KS, Russell CA, American Cancer Society Breast Cancer Advisory Group American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 57:75–89.  https://doi.org/10.3322/canjclin.57.2.75
  20. 20.
    Kuhl C, Weigel S, Schrading S, Arand B, Bieling H, König R, Tombach B, Leutner C, Rieber-Brambs A, Nordhoff D, Heindel W, Reiser M, Schild HH (2010) Prospective multicenter cohort study to refine management recommendations for women at elevated familial risk of breast cancer: the EVA trial. J Clin Oncol 28:1450–1457.  https://doi.org/10.1200/JCO.2009.23.0839 CrossRefGoogle Scholar
  21. 21.
    Warner E, Hill K, Causer P, Plewes D, Jong R, Yaffe M, Foulkes WD, Ghadirian P, Lynch H, Couch F, Wong J, Wright F, Sun P, Narod SA (2011) Prospective study of breast cancer incidence in women with a BRCA1 or BRCA2 mutation under surveillance with and without magnetic resonance imaging. J Clin Oncol 29:1664–1669.  https://doi.org/10.1200/JCO.2009.27.0835 CrossRefGoogle Scholar
  22. 22.
    Passaperuma K, Warner E, Causer PA, Hill KA, Messner S, Wong JW, Jong RA, Wright FC, Yaffe MJ, Ramsay EA, Balasingham S, Verity L, Eisen A, Curpen B, Shumak R, Plewes DB, Narod SA (2012) Long-term results of screening with magnetic resonance imaging in women with BRCA mutations. Br J Cancer 107:24–30.  https://doi.org/10.1038/bjc.2012.204 CrossRefGoogle Scholar
  23. 23.
    Skytte A-B, Gerdes A-M, Andersen MK, Sunde L, Brøndum-Nielsen K, Waldstrøm M, Kølvraa S, Crüger D (2010) Risk-reducing mastectomy and salpingo-oophorectomy in unaffected BRCA mutation carriers: uptake and timing. Clin Genet 77:342–349.  https://doi.org/10.1111/j.1399-0004.2009.01329.x CrossRefGoogle Scholar
  24. 24.
    Gilbert E, Zabor EC, Stempel M, Mangino D, Heerdt A, Pilewskie M (2017) Differences Among a modern cohort of BRCA mutation carriers choosing bilateral prophylactic mastectomies compared to breast surveillance. Ann Surg Oncol 24:3048–3054.  https://doi.org/10.1245/s10434-017-5976-2 CrossRefGoogle Scholar
  25. 25.
    Metcalfe KA, Mian N, Enmore M, Poll A, Llacuachaqui M, Nanda S, Sun P, Hughes KS, Narod SA (2012) Long-term follow-up of Jewish women with a BRCA1 and BRCA2 mutation who underwent population genetic screening. Breast Cancer Res Treat 133:735–740.  https://doi.org/10.1007/s10549-011-1941-0 CrossRefGoogle Scholar
  26. 26.
    Pujol P, Lasset C, Berthet P, Dugast C, Delaloge S, Fricker J-P, Tennevet I, Chabbert-Buffet N, This P, Baudry K, Lemonnier J, Roca L, Mijonnet S, Gesta P, Chiesa J, Dreyfus H, Vennin P, Delnatte C, Bignon YJ, Lortholary A, Prieur F, Gladieff L, Lesur A, Clough KB, Nogues C, Martin A-L, French Federation of Cancer Centres (FNCLCC) (2012) Uptake of a randomized breast cancer prevention trial comparing letrozole to placebo in BRCA1/2 mutations carriers: the LIBER trial. Fam Cancer 11:77–84.  https://doi.org/10.1007/s10689-011-9484-4 CrossRefGoogle Scholar
  27. 27.
    Schwartz MD, Isaacs C, Graves KD, Poggi E, Peshkin BN, Gell C, Finch C, Kelly S, Taylor KL, Perley L (2012) Long-term outcomes of BRCA1/BRCA2 testing: risk reduction and surveillance. Cancer 118:510–517.  https://doi.org/10.1002/cncr.26294 CrossRefGoogle Scholar
  28. 28.
    Lerman C, Hughes C, Croyle RT, Main D, Durham C, Snyder C, Bonney A, Lynch JF, Narod SA, Lynch HT (2000) Prophylactic surgery decisions and surveillance practices one year following BRCA1/2 testing. Prev Med (Baltim) 31:75–80.  https://doi.org/10.1006/pmed.2000.0684 CrossRefGoogle Scholar
  29. 29.
    Ludwig KK, Neuner J, Butler A, Geurts JL, Kong AL (2016) Risk reduction and survival benefit of prophylactic surgery in BRCA mutation carriers, a systematic review - full. Am J Surg 212:660–669.  https://doi.org/10.1016/j.amjsurg.2016.06.010 CrossRefGoogle Scholar
  30. 30.
    Metcalfe KA, Foulkes WD, Kim-Sing C, Ainsworth P, Rosen B, Armel S, Poll A, Eisen A, Gilchrist D, Chudley A, Ghadirian P, Maugard C, Lemire EG, Sun P, Narod SA (2008) Family history as a predictor of uptake of cancer preventive procedures by women with a BRCA1 or BRCA2 mutation. Clin Genet 73:474–479.  https://doi.org/10.1111/j.1399-0004.2008.00988.x CrossRefGoogle Scholar
  31. 31.
    Friebel TM, Domchek SM, Neuhausen SL, Wagner T, Evans DG, Isaacs C, Garber JE, Daly MB, Eeles R, Matloff E, Tomlinson G, Lynch HT, Tung N, Blum JL, Weitzel J, Rubinstein WS, Ganz PA, Couch F, Rebbeck TR (2007) Bilateral prophylactic oophorectomy and bilateral prophylactic mastectomy in a prospective cohort of unaffected BRCA1 and BRCA2 mutation carriers. Clin Breast Cancer 7:875–882.  https://doi.org/10.3816/CBC.2007.n.053 CrossRefGoogle Scholar
  32. 32.
    McGee J, Giannakeas V, Karlan B, Lubinski J, Gronwald J, Rosen B, McLaughlin J, Risch H, Sun P, Foulkes WD, Neuhausen SL, Kotsopoulos J, Narod SA (2017) Risk of breast cancer after a diagnosis of ovarian cancer in BRCA mutation carriers: is preventive mastectomy warranted? Gynecol Oncol 145:346–351.  https://doi.org/10.1016/j.ygyno.2017.02.032 CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Breast Surgical OncologyOrlando Health UF Health Cancer CenterOrlandoUSA
  2. 2.Department of Breast OncologyH. Lee Moffitt Cancer Center and Research InstituteTampaUSA
  3. 3.Department of BiostatisticsH. Lee Moffitt Cancer Center and Research InstituteOrlandoUSA

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