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Breast Cancer Surgery Trend Changes Since the Introduction of BRCA1/2 Mutation Screening: A Retrospective Cohort Analysis of 158 Mutation Carriers Treated at a Single Institution

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

Abstract

Background

Bilateral mastectomy in women diagnosed with unilateral breast cancer is on the rise in the USA. One contributing factor is increased awareness of contralateral breast cancer risk. Positive testing for deleterious mutation in BRCA1/2 is a concrete measure of this contributing factor. We hypothesize that breast cancer surgery trend change is temporally associated with the introduction of BRCA1/2 genetic testing around 1996.

Methods

Our study cohort included 158 BRCA1 or BRCA2 mutation carriers diagnosed with unilateral breast cancer between 1963 and 2009. Mutation carriers with ovarian cancer or bilateral breast cancer were excluded. Breast surgery and breast reconstruction surgery trends were analyzed according to year of breast cancer diagnosis or when bilateral mastectomy was performed, respectively.

Results

Surgery trends changed significantly over time. We observed a significant drop in the rate of unilateral mastectomy (P < 0.001) after the period 1996–2000, and the rate of bilateral mastectomy appears to be on the rise, up to 30.3% between 2006 and 2009. Breast reconstruction trends also changed significantly over time, with a significant rise in the rate of free flap reconstruction to 58.8% between 2006 and 2009.

Conclusions

Our results demonstrated a significant decrease in unilateral mastectomy with a rise in bilateral mastectomy after the period 1996–2000, a period which encompassed the year when genetic testing of the two BRCA1/2 genes became commercially available, hence supporting our hypothesis.

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Acknowledgment

This study is supported, in part, by the American College of Surgeons Faculty Research Fellowship, Commonwealth Tobacco Funds (Health Research Formula Fund), and Grant #IRG-78-002-26 from the American Cancer Society (J.T.).

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Authors and Affiliations

  1. Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA

    Angela Mislowsky MD, Susan Domchek MD, Cecilia Stroede MD, Meredith R. Bergey MS & Julia Tchou MD, PhD

  2. Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA

    Angela Mislowsky MD, Cecilia Stroede MD, Meredith R. Bergey MS, Seema S. Sonnad PhD & Julia Tchou MD, PhD

  3. Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA, USA

    Susan Domchek MD

  4. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA

    Seema S. Sonnad PhD

  5. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    Seema S. Sonnad PhD

  6. Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA, USA

    Liza Wu MD

  7. Division of Surgical Oncology, Rena Rowan Breast Center, Perelman Center for Advanced Medicine, Philadelphia, PA, USA

    Julia Tchou MD, PhD

Authors
  1. Angela Mislowsky MD
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  2. Susan Domchek MD
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  3. Cecilia Stroede MD
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  4. Meredith R. Bergey MS
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  5. Seema S. Sonnad PhD
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  6. Liza Wu MD
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  7. Julia Tchou MD, PhD
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Corresponding author

Correspondence to Julia Tchou MD, PhD.

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Mislowsky, A., Domchek, S., Stroede, C. et al. Breast Cancer Surgery Trend Changes Since the Introduction of BRCA1/2 Mutation Screening: A Retrospective Cohort Analysis of 158 Mutation Carriers Treated at a Single Institution. Ann Surg Oncol 18, 745–751 (2011). https://doi.org/10.1245/s10434-010-1381-9

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  • DOI: https://doi.org/10.1245/s10434-010-1381-9

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