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International Rates of Breast Reconstruction After Prophylactic Mastectomy in BRCA1 and BRCA2 Mutation Carriers

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

Abstract

Background

Breast reconstruction is an option for women with BRCA1 or BRCA2 mutations who elect to undergo prophylactic mastectomy to prevent breast cancer. We report on the uptake of breast reconstruction after prophylactic mastectomy in women with BRCA mutations from eight countries.

Methods

Women with a BRCA1 or BRCA2 mutation were questioned regarding their cancer preventive practices. Information was recorded on prophylactic mastectomy and breast reconstruction.

Results

A total of 1,635 women with a BRCA1 or BRCA2 mutation who elected to undergo prophylactic mastectomy from eight countries were included. A total of 1,137 women (69.5 %) had breast reconstruction after prophylactic mastectomy. A total of 58.7 % of women over the age of 45 years at the time of prophylactic mastectomy had breast reconstruction compared to 77.6 % of women 35 years of age or younger [odds ratio (OR) 0.36, 95 % confidence interval (CI) 0.26–0.50, p < 0.001]. In addition, 62.9 % of women with a breast cancer diagnosis (contralateral prophylactic mastectomy) had breast reconstruction after prophylactic mastectomy compared to 79.7 % of women without a previous breast cancer diagnosis (OR 0.48, 95 % CI 0.38–0.61, p < 0.001). A total of 66.9 % of women from Canada had breast reconstruction after mastectomy compared to 71.9 % of American women (OR 0.75, 95 % CI 0.59–0.96, p = 0.02).

Conclusions

The majority of women elect for breast reconstruction after prophylactic mastectomy. However, younger women and those without a previous diagnosis of breast cancer are more likely to have breast reconstruction than older women or those with a previous diagnosis of cancer.

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References

  1. Antoniou AC, Shenton A, Maher ER, et al. Parity and breast cancer risk among BRCA1 and BRCA2 mutation carriers. Breast Cancer Res. 2006;8:R72.

    Article  PubMed  Google Scholar 

  2. Chen S, Parmigiani G. Meta-analysis of BRCA1 and BRCA2 penetrance. J Clin Oncol. 2007;25:1329–33.

    Article  PubMed  Google Scholar 

  3. Metcalfe K, Gershman S, Lynch HT, et al. Predictors of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. Br J Cancer. 2011;104:1384–92.

    Article  PubMed  CAS  Google Scholar 

  4. Metcalfe K, Lynch HT, Ghadirian P, et al. Contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. J Clin Oncol. 2004;22:2328–35.

    Article  PubMed  CAS  Google Scholar 

  5. 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;93:1633–7.

    Article  PubMed  CAS  Google Scholar 

  6. Alderman AK, Hawley ST, Janz NK, et al. Racial and ethnic disparities in the use of postmastectomy breast reconstruction: results from a population-based study. J Clin Oncol. 2009;27:5325–30.

    Article  PubMed  Google Scholar 

  7. Hall SE, Holman CDcInequalities in breast cancer reconstructive surgery according to social and locational status in Western Australia. Eur J Surg Oncol. 2003;29:519–25.

    Article  PubMed  CAS  Google Scholar 

  8. Hvilsom GB, Holmich LR, Frederiksen K, et al. Socioeconomic position and breast reconstruction in Danish women. Acta Oncol. 2011;50:265–73.

    Article  PubMed  Google Scholar 

  9. Jeevan R, Cromwell DA, Browne JP, et al. Regional variation in use of immediate breast reconstruction after mastectomy for breast cancer in England. Eur J Surg Oncol. 2010;36:750–5.

    Article  PubMed  CAS  Google Scholar 

  10. Yu KD, Di GH, Wu J, et al. Development and trends of surgical modalities for breast cancer in China: a review of 16-year data. Ann Surg Oncol. 2007;14:2502–9.

    Article  PubMed  Google Scholar 

  11. Metcalfe KA, Birenbaum-Carmeli D, Lubinski J, et al. International variation in rates of uptake of preventive options in BRCA1 and BRCA2 mutation carriers. Int J Cancer. 2008;122:2017–22.

    Article  PubMed  CAS  Google Scholar 

  12. Metcalfe KA, Snyder C, Seidel J, et al. The use of preventive measures among healthy women who carry a BRCA1 or BRCA2 mutation. Fam Cancer. 2005;4:97–103.

    Article  PubMed  Google Scholar 

  13. Baxter N, Goel V, Semple JL. Rates and regional variation of breast reconstruction following mastectomy for breast cancer: viewpoint from a single payer medical system. 2002.

  14. Polednak AP. Postmastectomy breast reconstruction in Connecticut: trends and predictors. Plast Reconstr Surg. 1999;104:669–73.

    PubMed  CAS  Google Scholar 

  15. Alderman AK, McMahon L Jr, Wilkins EG. The national utilization of immediate and early delayed breast reconstruction and the effect of sociodemographic factors. Plast Reconstr Surg. 2003;111:695–703.

    Article  PubMed  Google Scholar 

  16. Polednak AP. How frequent is postmastectomy breast reconstructive surgery? A study linking two statewide databases. Plast Reconstr Surg. 2001;108:73–7.

    Article  PubMed  CAS  Google Scholar 

  17. Alderman AK, Wei Y, Birkmeyer JD. Use of breast reconstruction after mastectomy following the Women’s Health and Cancer Rights Act. JAMA. 2006;295:387–8.

    PubMed  CAS  Google Scholar 

  18. Joslyn SA. Patterns of care for immediate and early delayed breast reconstruction following mastectomy. Plast Reconstr Surg. 2005;115:1289–96.

    Article  PubMed  CAS  Google Scholar 

  19. Rosson GD, Singh NK, Ahuja N, et al. Multilevel analysis of the impact of community vs patient factors on access to immediate breast reconstruction following mastectomy in Maryland. Arch Surg. 2008;143:1076–81.

    Article  PubMed  Google Scholar 

  20. Tseng WH, Stevenson TR, Canter RJ, et al. Sacramento area breast cancer epidemiology study: use of postmastectomy breast reconstruction along the rural-to-urban continuum. Plast Reconstr Surg. 2010;126:1815–24.

    Article  PubMed  CAS  Google Scholar 

  21. Kruper L, Holt A, Xu XX, et al. Disparities in reconstruction rates after mastectomy: patterns of care and factors associated with the use of breast reconstruction in Southern California. Ann Surg Oncol. 2011;18:2158–65.

    Article  PubMed  Google Scholar 

  22. Morrow M, Scott SK, Menck HR, et al. Factors influencing the use of breast reconstruction postmastectomy: a National Cancer Data Base study. J Am Coll Surg. 2001;192:1–8.

    Article  PubMed  CAS  Google Scholar 

  23. Tseng JF, Kronowitz SJ, Sun CC, et al. The effect of ethnicity on immediate reconstruction rates after mastectomy for breast cancer. Cancer. 2004;101:1514–23.

    Article  PubMed  Google Scholar 

  24. Metcalfe KA, Goel V, Lickley L, et al. Prophylactic bilateral mastectomy: patterns of practice. Cancer. 2002;95:236–42.

    Article  PubMed  Google Scholar 

  25. Metcalfe KA, Lubinski J, Ghadirian P, et al. Predictors of contralateral prophylactic mastectomy in women with a BRCA1 or BRCA2 mutation: the Hereditary Breast Cancer Clinical Study Group. J Clin Oncol. 2008;26:1093–7.

    Article  PubMed  Google Scholar 

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Acknowledgment

Dr. John Semple is supported through the Canadian Breast Cancer Foundation (Ontario Chapter).

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Women’s College Research Institute, Toronto, ON, Canada

    John Semple MD, Kelly A. Metcalfe RN, PhD, Ping Sun PhD & Steven A. Narod MD

  2. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada

    Kelly A. Metcalfe RN, PhD

  3. Department of Preventive Medicine and Public Health, Creighton University School of Medicine, Omaha, NE, USA

    Henry T. Lynch MD

  4. BC Cancer Agency, Vancouver, BC, Canada

    Charmaine Kim-Sing MD

  5. Division of Human Genetics, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA

    Leigha Senter MS, CGC

  6. Moffitt Cancer Center, Tampa, FL, USA

    Tuya Pal MD

  7. London Regional Cancer Program, London, ON, Canada

    Peter Ainsworth MD

  8. Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland

    Jan Lubinski MD, PhD

  9. Beth Israel Deaconess Hospital, Boston, MA, USA

    Nadine Tung MD

  10. Genomic Medicine Institute and Center for Personalized Genetic Healthcare, Cleveland, OH, USA

    Charis Eng MD, PhD

  11. Taussig Cancer Institute, Cleveland, OH, USA

    Charis Eng MD, PhD

  12. Cleveland Clinic, Stanley Shalom Zielony Institute of Nursing Excellence, Cleveland, OH, USA

    Charis Eng MD, PhD

  13. Department of Genetics and Genome Sciences, and CASE Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Charis Eng MD, PhD

  14. Department of Medicine Genetics, University of Alberta, Edmonton, AB, Canada

    Donna Gilchrist MD

  15. Texas Oncology-Baylor Charles A. Sammons Cancer Center, Dallas, TX, USA

    Joanne Blum MD, PhD

  16. Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA

    Susan L. Neuhausen PhD

  17. Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

    Christian F. Singer MD

  18. University of Montreal, Montreal, QC, Canada

    Parviz Ghadirian PhD

Authors
  1. John Semple MD
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  2. Kelly A. Metcalfe RN, PhD
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  3. Henry T. Lynch MD
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  4. Charmaine Kim-Sing MD
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  5. Leigha Senter MS, CGC
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  6. Tuya Pal MD
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  7. Peter Ainsworth MD
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  8. Jan Lubinski MD, PhD
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  9. Nadine Tung MD
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  10. Charis Eng MD, PhD
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  11. Donna Gilchrist MD
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  12. Joanne Blum MD, PhD
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  13. Susan L. Neuhausen PhD
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  14. Christian F. Singer MD
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  15. Parviz Ghadirian PhD
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  16. Ping Sun PhD
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  17. Steven A. Narod MD
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Consortia

The Hereditary Breast Cancer Clinical Study Group

Corresponding author

Correspondence to Kelly A. Metcalfe RN, PhD.

Additional information

The members of The Hereditary Breast Cancer Clinical study group are listed in the Appendix.

Appendix

Appendix

Other members of the Hereditary Breast Cancer Clinical Study Group who contributed to the study: William D. Foulkes, Andrea Eisen, Ophira Ginsburg, Mary Daly, Dawna Gilchrist, Albert Chudley, Talia Donenberg, Beth Karlan, Jeffrey Weitzel, Dana Zakalik, Judy Garber, Edmond Lemire, Dominique Stoppa-Lyonnet, Olufunmilayo I. Olopade, Sofia Merajver, Howard Saal, Louise Bordeleau, Carey A. Cullinane, Wendy McKinnon, Marie Wood, Daniel Rayson, Wendy Meschino, Jane McLennan, Josephine Wagner Costalas, Pal Moller, Ava Kwong, Claudine Isaacs, Fergus Couch, Siranoush Manoukian, and Taya Fallen.

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Semple, J., Metcalfe, K.A., Lynch, H.T. et al. International Rates of Breast Reconstruction After Prophylactic Mastectomy in BRCA1 and BRCA2 Mutation Carriers. Ann Surg Oncol 20, 3817–3822 (2013). https://doi.org/10.1245/s10434-013-3040-4

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  • DOI: https://doi.org/10.1245/s10434-013-3040-4

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