Annals of Surgical Oncology

, Volume 21, Issue 11, pp 3466–3472 | Cite as

Predictors that Influence Contralateral Prophylactic Mastectomy Election Among Women with Ductal Carcinoma In Situ Who Were Evaluated for BRCA Genetic Testing

  • Nisreen Elsayegh
  • Henry M. Kuerer
  • Heather Lin
  • Angelica M. Gutierrez Barrera
  • Michelle Jackson
  • Kimberly I. Muse
  • Jennifer K. Litton
  • Constance Albarracin
  • Aimaz Afrough
  • Gabriel N. Hortobagyi
  • Banu K. Arun
Breast Oncology

Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

References

  1. 1.
    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.Google Scholar
  2. 2.
    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.PubMedCrossRefGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    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.CrossRefGoogle Scholar
  5. 5.
    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.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    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.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 10.
    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.Google Scholar
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    Hwang ES, et al. Ductal carcinoma in situ in BRCA mutation carriers. J Clin Oncol. 2007;25:642–47.PubMedCrossRefGoogle Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    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.
  16. 16.
    Snedecor GW, Cochran WG. Statistical methods. 7th ed. Ames: The Iowa State University Press; 1980.Google Scholar
  17. 17.
    Hosmer DW, Lemeshow S. Applied logistic regression. 2nd ed. New York: Wiley; 2000.CrossRefGoogle Scholar
  18. 18.
    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.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Litton JK, et al. Perception of screening and risk reduction surgeries in patients tested for a BRCA deleterious mutation. Cancer 2009;115:1598–604.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    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.CrossRefGoogle Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 22.
    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.PubMedCrossRefGoogle Scholar
  23. 23.
    Goldflam K, Hunt KK, Gershenwald JE, et al. Contralateral prophylactic mastectomy: predictors of significant histologic findings. Cancer. 2004;101:1977–86.PubMedCrossRefGoogle Scholar
  24. 24.
    Alvarado R, et al. Biology, treatment, and outcome in very young and old women with DCIS. Ann Surg Oncol. 2012;19:3777–84.PubMedCrossRefGoogle Scholar
  25. 25.
    Montgomery LL, Tran KN, Heelan MC, et al. Issues of regret in women with contralateral prophylactic mastectomies. Ann Surg Oncol. 1999;6:546–52.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Nisreen Elsayegh
    • 1
  • Henry M. Kuerer
    • 2
  • Heather Lin
    • 3
  • Angelica M. Gutierrez Barrera
    • 1
  • Michelle Jackson
    • 4
  • Kimberly I. Muse
    • 4
  • Jennifer K. Litton
    • 1
  • Constance Albarracin
    • 1
  • Aimaz Afrough
    • 1
  • Gabriel N. Hortobagyi
    • 1
  • Banu K. Arun
    • 1
    • 4
  1. 1.Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Department of Clinical Cancer GeneticsThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations