Annals of Surgical Oncology

, Volume 18, Issue 9, pp 2515–2520 | Cite as

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

  • Natasha M. Rueth
  • Melissa McMahon
  • Amanda K. Arrington
  • Karen Swenson
  • Joseph Leach
  • Todd M. Tuttle
Breast Oncology



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.


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.


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.


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.


  1. 1.
    Hartmann LC, Schaid DJ, Woods JE, Crotty TP, Myers JL, Arnold PG, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med. 1999;340:77–84.PubMedCrossRefGoogle Scholar
  2. 2.
    McLaughlin CC, Lillquist PP, Edge SB. Surveillance of prophylactic mastectomy: trends in use from 1995 through 2005. Cancer. 2009;115:5404–12.PubMedCrossRefGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    Friebel TM, Domchek SM, Neuhausen SL, Wagner T, Evans DG, Isaacs C, et al. Bilateral prophylactic oophorectomy and bilateral prophylactic mastectomy in a prospective cohort of unaffected BRCA1 and BRCA2 mutation carriers. Clin Breast Cancer. 2007;7:875–82.PubMedCrossRefGoogle Scholar
  5. 5.
    Meijers-Heijboer H, van Geel B, van Putten WL, Henzen-Logmans SC, Seynaeve C, Menke-Pluymers MB, et al. Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med. 2001;345:159–64.PubMedCrossRefGoogle Scholar
  6. 6.
    Litton JK, Westin SN, Ready K, Sun CC, Peterson SK, Meric-Bernstam F, et al. Perception of screening and risk reduction surgeries in patients tested for a BRCA deleterious mutation. Cancer. 2009;115:1598–604.PubMedCrossRefGoogle Scholar
  7. 7.
    Kaas R, Verhoef S, Wesseling J, Rookus MA, Oldenburg HS, Peeters MJ, et al. Prophylactic mastectomy in BRCA1 and BRCA2 mutation carriers: very low risk for subsequent breast cancer. Ann Surg. 2010;251:488–92.PubMedCrossRefGoogle Scholar
  8. 8.
    Fatouros M, Baltoyiannis G, Roukos DH. The predominant role of surgery in the prevention and new trends in the surgical treatment of women with BRCA1/2 mutations. Ann Surg Oncol. 2008;15:21–33.PubMedCrossRefGoogle Scholar
  9. 9.
    MacDonald DJ, Sarna L, Weitzel JN, Ferrell B. Women’s perceptions of the personal and family impact of genetic cancer risk assessment: focus group findings. J Genet Couns. 2010;19:148–60.PubMedCrossRefGoogle Scholar
  10. 10.
    Ruddy KJ, Gelber S, Shin J, Garber JE, Rosenberg R, Przypysny M, et al. Genetic testing in young women with breast cancer: results from a Web-based survey. Ann Oncol. 2010;21:741–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Brown KL, Hutchison R, Zinberg RE, McGovern MM. Referral and experience with genetic testing among women with early onset breast cancer. Genet Test. 2005;9:301–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Interim final rules prohibiting discrimination based on genetic information in health insurance coverage and group health plans. Interim final rules with request for comments. Fed Regist. 2009;74:51663–2138.Google Scholar
  13. 13.
    Leach MO, Boggis CR, Dixon AK, Easton DF, Eeles RA, Evans DG, et al. Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet. 2005;365:1769–78.PubMedCrossRefGoogle Scholar
  14. 14.
    Warner E, Messersmith H, Causer P, Eisen A, Shumak R, Plewes D. Systematic review: using magnetic resonance imaging to screen women at high risk for breast cancer. Ann Intern Med. 2008;148:671–9.PubMedGoogle Scholar
  15. 15.
    Saslow D, Boetes C, Burke W, Harms S, Leach MO, Lehman CD, et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007;57:75–89.PubMedCrossRefGoogle Scholar
  16. 16.
    Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90:1371–88.PubMedCrossRefGoogle Scholar
  17. 17.
    Vogel VG, Costantino JP, Wickerham DL, Cronin WM, Cecchini RS, Atkins JN, et al. Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA. 2006;295:2727–41.PubMedCrossRefGoogle Scholar
  18. 18.
    Lostumbo L, Carbine N, Wallace J, Ezzo J (2004) Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev. 18:002748.Google Scholar
  19. 19.
    Altschuler A, Nekhlyudov L, Rolnick SJ, Greene SM, Elmore JG, West CN, et al. Positive, negative, and disparate—women’s differing long-term psychosocial experiences of bilateral or contralateral prophylactic mastectomy. Breast J. 2008;14:25–32.PubMedCrossRefGoogle Scholar
  20. 20.
    Geiger AM, Nekhlyudov L, Herrinton LJ, Rolnick SJ, Greene SM, West CN, et al. Quality of life after bilateral prophylactic mastectomy. Ann Surg Oncol. 2007;14:686–94.PubMedCrossRefGoogle Scholar
  21. 21.
    Metcalfe KA, Esplen MJ, Goel V, Narod SA. Psychosocial functioning in women who have undergone bilateral prophylactic mastectomy. Psychooncology. 2004;13:14–25.PubMedCrossRefGoogle Scholar
  22. 22.
    Brandberg Y, Sandelin K, Erikson S, Jurell G, Liljegren A, Lindblom A, et al. Psychological reactions, quality of life, and body image after bilateral prophylactic mastectomy in women at high risk for breast cancer: a prospective 1-year follow-up study. J Clin Oncol. 2008;26:3943–9.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Natasha M. Rueth
    • 1
  • Melissa McMahon
    • 2
  • Amanda K. Arrington
    • 1
  • Karen Swenson
    • 3
  • Joseph Leach
    • 3
  • Todd M. Tuttle
    • 1
  1. 1.Department of Surgery, Division of Surgical OncologyUniversity of MinnesotaMinneapolisUSA
  2. 2.Division of EpidemiologyUniversity of Minnesota School of Public HealthMinneapolisUSA
  3. 3.Park Nicollet Health ServicesMinneapolisUSA

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