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Prophylactic Risk-Reducing Surgery for Breast Cancer

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Personalized Treatment of Breast Cancer

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Abstract

Advances in the understanding of the genetics and biology of breast cancer are defining patients at increased risk for the development of breast cancer. Prophylactic risk-reducing mastectomy and bilateral salpingo-oophorectomy are very good options for reducing breast cancer risk in selected patients with elevated breast cancer risk. Technical approaches to prophylactic surgery are evolving and are leading to improved patient cosmetic outcomes and lower morbidity. Decisions regarding utilization of these procedures for patients should take into account a specific patient’s risk for developing breast cancer based on genetic, family, and personal medical history; patient age; and comorbid conditions. Limitations of prophylactic surgical approaches, alternatives, and side effects of prophylactic operations should also be considered carefully with patients who are considering these surgical interventions for breast cancer risk reduction.

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References

  1. Miki Y, Swensen J, Shattuck-Eidens D et al (1994) A strong candidate for the breast and ovarian cancer susceptibility gene BRCA1. Science 266:66–71

    Article  CAS  PubMed  Google Scholar 

  2. Wooster R, Bignell G, Lancaster J et al (1995) Identification of the breast cancer susceptibility gene BRCA2. Nature 378:789–792

    Article  CAS  PubMed  Google Scholar 

  3. Janjan NA, Zellmer DL (1992) Calculated risk of breast cancer following mantle irradiation determined by measured dose. Cancer Detect Prev 16:273–282

    CAS  PubMed  Google Scholar 

  4. Warner E, Hill K, Causer P et al (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

    Article  PubMed  Google Scholar 

  5. Fisher B, Costantino JP, Wickerham DL et al (1998) Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst 90:1371–1388

    Article  CAS  PubMed  Google Scholar 

  6. Rebbeck TR, Friebel T, Lynch HT et al (2004) Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol 22:1055–1062

    Article  PubMed  Google Scholar 

  7. Narod SA (2010) BRCA mutations in the management of breast cancer: the state of the art. Nat Rev Clin Oncol 7:702–707

    Article  CAS  PubMed  Google Scholar 

  8. Filippini SE, Vega A (2013) Breast cancer genes: beyond BRCA1 and BRCA2. Front Biosci (Landmark Ed) 18:1358–1372

    Article  CAS  Google Scholar 

  9. Chen S, Parmigiani G (2007) Meta-analysis of BRCA1 and BRCA2 penetrance. J Clin Oncol 25:1329–1333

    Article  PubMed  PubMed Central  Google Scholar 

  10. Valachis A, Nearchou AD, Lind P (2014) Surgical management of breast cancer in BRCA-mutation carriers: a systematic review and meta-analysis. Breast Cancer Res Treat 144:443–455

    Article  CAS  PubMed  Google Scholar 

  11. Verhoog LC, Brekelmans CT, Seynaeve C et al (2000) Contralateral breast cancer risk is influenced by the age at onset in BRCA1-associated breast cancer. Br J Cancer 83:384–386

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Metcalfe K, Lynch HT, Ghadirian P et al (2004) Contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. J Clin Oncol 22:2328–2335

    Article  CAS  PubMed  Google Scholar 

  13. Green L, Meric-Bernstam F (2011) Risk of ipsilateral and contralateral cancer in BRCA mutation carriers with breast cancer. Curr Breast Cancer Rep 3:151–155

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Tan MH, Mester JL, Ngeow J et al (2012) Lifetime cancer risks in individuals with germline PTEN mutations. Clin Cancer Res 18:400–407

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Boardman LA, Thibodeau SN, Schaid DJ et al (1998) Increased risk for cancer in patients with the Peutz-Jeghers syndrome. Ann Intern Med 128:896–899

    Article  CAS  PubMed  Google Scholar 

  16. Sidransky D, Tokino T, Helzlsouer K et al (1992) Inherited p53 gene mutations in breast cancer. Cancer Res 52:2984–2986

    CAS  PubMed  Google Scholar 

  17. Euhus D (2014) Genetic testing today. Ann Surg Oncol 21:3209–3215

    Article  PubMed  Google Scholar 

  18. Oppong BA, King TA (2011) Recommendations for women with lobular carcinoma in situ (LCIS). Oncology (Williston Park) 25:1051-6–1058

    Google Scholar 

  19. Chuba PJ, Hamre MR, Yap J et al (2005) Bilateral risk for subsequent breast cancer after lobular carcinoma-in-situ: analysis of surveillance, epidemiology, and end results data. J Clin Oncol 23:5534–5541

    Article  PubMed  Google Scholar 

  20. Haagensen CD, Lane N, Lattes R et al (1978) Lobular neoplasia (so-called lobular carcinoma in situ) of the breast. Cancer 42:737–769

    Article  CAS  PubMed  Google Scholar 

  21. Oskar S, Muhsen S, Sung J et al (2011) Chemoprevention among women with lobular carcinoma in situ. Ann Surg Oncol 18:S59

    Google Scholar 

  22. Bunting PW, Cyr AE, Gao F et al (2014) Sentinel lymph node biopsy during prophylactic mastectomy: is there a role? J Surg Oncol 109:747–750

    Article  PubMed  Google Scholar 

  23. Grobmyer SR, Mortellaro VE, Marshall J et al (2008) Is there a role for routine use of MRI in selection of patients for breast-conserving cancer therapy? J Am Coll Surg 206:1045–1050; discussion 1050–2

    Article  PubMed  Google Scholar 

  24. King TA, Gurevich I, Sakr R et al (2011) Occult malignancy in patients undergoing contralateral prophylactic mastectomy. Ann Surg 254:2–7

    Article  PubMed  Google Scholar 

  25. Nichols HB, Berrington de Gonzalez A, Lacey JV Jr et al (2011) Declining incidence of contralateral breast cancer in the United States from 1975 to 2006. J Clin Oncol 29:1564–1569

    Article  PubMed  PubMed Central  Google Scholar 

  26. Broet P, de la Rochefordiere A, Scholl SM et al (1995) Contralateral breast cancer: annual incidence and risk parameters. J Clin Oncol 13:1578–1583

    CAS  PubMed  Google Scholar 

  27. Black WC, Nease RF Jr, Tosteson AN (1995) Perceptions of breast cancer risk and screening effectiveness in women younger than 50 years of age. J Natl Cancer Inst 87:720–731

    Article  CAS  PubMed  Google Scholar 

  28. Alexander NE, Ross J, Sumner W et al (1996) The effect of an educational intervention on the perceived risk of breast cancer. J Gen Intern Med 11:92–97

    Article  CAS  PubMed  Google Scholar 

  29. Rosenberg SM, Partridge AH (2014) Contralateral prophylactic mastectomy: an opportunity for shared decision making. JAMA Surg 149(6):589–590

    Article  PubMed  PubMed Central  Google Scholar 

  30. Wainberg S, Husted J (2004) Utilization of screening and preventive surgery among unaffected carriers of a BRCA1 or BRCA2 gene mutation. Cancer Epidemiol Biomarkers Prev 13:1989–1995

    CAS  PubMed  Google Scholar 

  31. Skytte AB, Gerdes AM, Andersen MK et al (2010) Risk-reducing mastectomy and salpingo-oophorectomy in unaffected BRCA mutation carriers: uptake and timing. Clin Genet 77:342–349

    Article  CAS  PubMed  Google Scholar 

  32. Metcalfe KA, Birenbaum-Carmeli D, Lubinski J et al (2008) International variation in rates of uptake of preventive options in BRCA1 and BRCA2 mutation carriers. Int J Cancer 122:2017–2022

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Beattie MS, Crawford B, Lin F et al (2009) Uptake, time course, and predictors of risk-reducing surgeries in BRCA carriers. Genet Test Mol Biomarkers 13:51–56

    Article  PubMed  PubMed Central  Google Scholar 

  34. Goldschmidt RA, Victor TA (1996) Lobular carcinoma in situ of the breast. Semin Surg Oncol 12:314–320

    Article  CAS  PubMed  Google Scholar 

  35. Burke EE, Portschy PR, Tuttle TM (2014) Prophylactic mastectomy: who needs it, when and why. J Surg Oncol 111(1):91–95

    Article  PubMed  Google Scholar 

  36. Portschy PR, Marmor S, Nzara R et al (2013) Trends in incidence and management of lobular carcinoma in situ: a population-based analysis. Ann Surg Oncol 20:3240–3246

    Article  PubMed  Google Scholar 

  37. Newman LA (2014) Contralateral prophylactic mastectomy: is it a reasonable option? JAMA 312:895–897

    Article  CAS  PubMed  Google Scholar 

  38. Kurian AW, Lichtensztajn DY, Keegan TH et al (2014) Use of and mortality after bilateral mastectomy compared with other surgical treatments for breast cancer in California, 1998–2011. JAMA 312:902–914

    Article  CAS  PubMed  Google Scholar 

  39. King TA, Sakr R, Patil S et al (2011) Clinical management factors contribute to the decision for contralateral prophylactic mastectomy. J Clin Oncol 29:2158–2164

    Article  PubMed  Google Scholar 

  40. Guth U, Myrick ME, Viehl CT et al (2012) Increasing rates of contralateral prophylactic mastectomy – a trend made in USA? Eur J Surg Oncol 38:296–301

    Article  CAS  PubMed  Google Scholar 

  41. Den Heijer M, van Asperen CJ, Harris H et al (2013) International variation in physicians’ attitudes towards prophylactic mastectomy – comparison between France, Germany, the Netherlands and the United Kingdom. Eur J Cancer 49:2798–2805

    Article  Google Scholar 

  42. Crowe JP Jr, Kim JA, Yetman R et al (2004) Nipple-sparing mastectomy: technique and results of 54 procedures. Arch Surg 139:148–150

    Article  PubMed  Google Scholar 

  43. Kronowitz SJ (2010) Delayed-immediate breast reconstruction: technical and timing considerations. Plast Reconstr Surg 125:463–474

    Article  CAS  PubMed  Google Scholar 

  44. Semple J, Metcalfe KA, Lynch HT et al (2013) International rates of breast reconstruction after prophylactic mastectomy in BRCA1 and BRCA2 mutation carriers. Ann Surg Oncol 20:3817–3822

    Article  PubMed  PubMed Central  Google Scholar 

  45. Garcia-Etienne CA, Cody Iii HS 3rd, Disa JJ et al (2009) Nipple-sparing mastectomy: initial experience at the Memorial Sloan-Kettering Cancer Center and a comprehensive review of literature. Breast J 15:440–449

    Article  PubMed  Google Scholar 

  46. Reynolds C, Davidson JA, Lindor NM et al (2011) Prophylactic and therapeutic mastectomy in BRCA mutation carriers: can the nipple be preserved? Ann Surg Oncol 18:3102–3109

    Article  PubMed  Google Scholar 

  47. Peled AW, Irwin CS, Hwang ES et al (2014) Total skin-sparing mastectomy in BRCA mutation carriers. Ann Surg Oncol 21:37–41

    Article  PubMed  Google Scholar 

  48. McLaughlin SA, Stempel M, Morris EA et al (2008) Can magnetic resonance imaging be used to select patients for sentinel lymph node biopsy in prophylactic mastectomy? Cancer 112:1214–1221

    Article  PubMed  Google Scholar 

  49. Czyszczon IA, Roland L, Sahoo S (2012) Routine prophylactic sentinel lymph node biopsy is not indicated in women undergoing prophylactic mastectomy. J Surg Oncol 105:650–654

    Article  PubMed  Google Scholar 

  50. Camp MS, Coopey SB, Tang R et al (2014) Management of positive sub-areolar/nipple duct margins in nipple-sparing mastectomies. Breast J 20:402–407

    Article  PubMed  Google Scholar 

  51. Goldflam K, Hunt KK, Gershenwald JE et al (2004) Contralateral prophylactic mastectomy. Predictors of significant histologic findings. Cancer 101:1977–1986

    Article  PubMed  Google Scholar 

  52. Lostumbo L, Carbine NE, Wallace J (2010) Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev 11:CD002748

    PubMed  Google Scholar 

  53. Eck DL, Perdikis G, Rawal B et al (2014) Incremental risk associated with contralateral prophylactic mastectomy and the effect on adjuvant therapy. Ann Surg Oncol 21:3297–3303

    Article  PubMed  Google Scholar 

  54. Miller ME, Czechura T, Martz B et al (2013) Operative risks associated with contralateral prophylactic mastectomy: a single institution experience. Ann Surg Oncol 20:4113–4120

    Article  PubMed  Google Scholar 

  55. Osman F, Saleh F, Jackson TD et al (2013) Increased postoperative complications in bilateral mastectomy patients compared to unilateral mastectomy: an analysis of the NSQIP database. Ann Surg Oncol 20:3212–3217

    Article  PubMed  Google Scholar 

  56. Contant CM, Menke-Pluijmers MB, Seynaeve C et al (2002) Clinical experience of prophylactic mastectomy followed by immediate breast reconstruction in women at hereditary risk of breast cancer (HB(O)C) or a proven BRCA1 and BRCA2 germ-line mutation. Eur J Surg Oncol 28:627–632

    Article  CAS  PubMed  Google Scholar 

  57. Domchek SM, Friebel TM, Singer CF et al (2010) Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA 304:967–975

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Kaas R, Verhoef S, Wesseling J et al (2010) Prophylactic mastectomy in BRCA1 and BRCA2 mutation carriers: very low risk for subsequent breast cancer. Ann Surg 251:488–492

    Article  PubMed  Google Scholar 

  59. Hartmann LC, Schaid DJ, Woods JE et al (1999) Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med 340:77–84

    Article  CAS  PubMed  Google Scholar 

  60. McDonnell SK, Schaid DJ, Myers JL et al (2001) Efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer. J Clin Oncol 19:3938–3943

    CAS  PubMed  Google Scholar 

  61. Narod SA (2011) The impact of contralateral mastectomy on mortality in BRCA1 and BRCA2 mutation carriers with breast cancer. Breast Cancer Res Treat 128:581–583

    Article  CAS  PubMed  Google Scholar 

  62. Metcalfe K, Gershman S, Ghadirian P et al (2014) Contralateral mastectomy and survival after breast cancer in carriers of BRCA1 and BRCA2 mutations: retrospective analysis. BMJ 348:g226

    Article  PubMed  PubMed Central  Google Scholar 

  63. Fayanju OM, Stoll CR, Fowler S et al (2014) Contralateral prophylactic mastectomy after unilateral breast cancer: a systematic review and meta-analysis. Ann Surg 260:1000–1010

    Article  PubMed  PubMed Central  Google Scholar 

  64. Yao K, Winchester DJ, Czechura T et al (2013) Contralateral prophylactic mastectomy and survival: report from the National Cancer Data Base, 1998–2002. Breast Cancer Res Treat 142:465–476

    Article  PubMed  Google Scholar 

  65. Geiger AM, Nekhlyudov L, Herrinton LJ et al (2007) Quality of life after bilateral prophylactic mastectomy. Ann Surg Oncol 14:686–694

    Article  PubMed  Google Scholar 

  66. Altschuler A, Nekhlyudov L, Rolnick SJ et al (2008) Positive, negative, and disparate – women’s differing long-term psychosocial experiences of bilateral or contralateral prophylactic mastectomy. Breast J 14:25–32

    Article  PubMed  Google Scholar 

  67. Tuttle TM, Abbott A, Arrington A et al (2010) The increasing use of prophylactic mastectomy in the prevention of breast cancer. Curr Oncol Rep 12:16–21

    Article  PubMed  Google Scholar 

  68. Montgomery LL, Tran KN, Heelan MC et al (1999) Issues of regret in women with contralateral prophylactic mastectomies. Ann Surg Oncol 6:546–552

    Article  CAS  PubMed  Google Scholar 

  69. Brandberg Y, Sandelin K, Erikson S et al (2008) 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 26:3943–3949

    Article  PubMed  Google Scholar 

  70. van Oostrom I, Meijers-Heijboer H, Lodder LN et al (2003) Long-term psychological impact of carrying a BRCA1/2 mutation and prophylactic surgery: a 5-year follow-up study. J Clin Oncol 21:3867–3874

    Article  PubMed  Google Scholar 

  71. Gahm J, Wickman M, Brandberg Y (2010) Bilateral prophylactic mastectomy in women with inherited risk of breast cancer–prevalence of pain and discomfort, impact on sexuality, quality of life and feelings of regret two years after surgery. Breast 19:462–469

    Article  PubMed  Google Scholar 

  72. Wasteson E, Sandelin K, Brandberg Y et al (2011) High satisfaction rate ten years after bilateral prophylactic mastectomy – a longitudinal study. Eur J Cancer Care (Engl) 20:508–513

    Article  CAS  Google Scholar 

  73. Finch A, Beiner M, Lubinski J et al (2006) Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 Mutation. JAMA 296:185–192

    Article  CAS  PubMed  Google Scholar 

  74. Rebbeck TR, Levin AM, Eisen A et al (1999) Breast cancer risk after bilateral prophylactic oophorectomy in BRCA1 mutation carriers. J Natl Cancer Inst 91:1475–1479

    Article  CAS  PubMed  Google Scholar 

  75. Kauff ND, Domchek SM, Friebel TM et al (2008) Risk-reducing salpingo-oophorectomy for the prevention of BRCA1- and BRCA2-associated breast and gynecologic cancer: a multicenter, prospective study. J Clin Oncol 26:1331–1337

    Article  PubMed  PubMed Central  Google Scholar 

  76. Eisen A, Lubinski J, Klijn J et al (2005) Breast cancer risk following bilateral oophorectomy in BRCA1 and BRCA2 mutation carriers: an international case-control study. J Clin Oncol 23:7491–7496

    Article  PubMed  Google Scholar 

  77. Antoniou AC, Casadei S, Heikkinen T et al (2014) Breast-cancer risk in families with mutations in PALB2. N Engl J Med 371:497–506

    Article  PubMed  PubMed Central  Google Scholar 

  78. Goldgar DE, Healey S, Dowty JG et al (2011) Rare variants in the ATM gene and risk of breast cancer. Breast Cancer Res 13:R73

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Lalloo F, Evans DG (2012) Familial breast cancer. Clin Genet 82:105–114

    Article  CAS  PubMed  Google Scholar 

  80. Mester J, Eng C (2015) Cowden syndrome: recognizing and managing a not-so-rare hereditary cancer syndrome. J Surg Oncol 111(1):125–130

    Article  PubMed  Google Scholar 

  81. Hearle N, Schumacher V, Menko FH et al (2006) Frequency and spectrum of cancers in the Peutz-Jeghers syndrome. Clin Cancer Res 12:3209–3215

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Section of Surgical Oncology, Cleveland Clinic, 9500 Euclid Ave./A81, Cleveland, OH, 44118, USA

    Mihir M. Shah, Holly J. Pederson, Joseph P. Crowe & Stephen R. Grobmyer

  2. Breast Services, Cleveland Clinic, Cleveland, OH, USA

    Mihir M. Shah, Holly J. Pederson, Joseph P. Crowe & Stephen R. Grobmyer

  3. Division of Plastic and Reconstructive Surgery, Cleveland Clinic, Cleveland, OH, USA

    Risal Djohan & Stephen R. Grobmyer

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  1. Mihir M. Shah
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  2. Holly J. Pederson
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  3. Risal Djohan
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  4. Joseph P. Crowe
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  5. Stephen R. Grobmyer
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Corresponding author

Correspondence to Stephen R. Grobmyer .

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Editors and Affiliations

  1. Department of Breast Surgery Graduate Sc, Kyoto University, Kyoto, Kyoto, Japan

    Masakazu Toi

  2. Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA

    Eric Winer

  3. Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, Cambridgeshire, United Kingdom

    John Benson

  4. University of Arkansas for Medical Scien, Little Rock, Arkansas, USA

    Suzanne Klimberg

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Shah, M.M., Pederson, H.J., Djohan, R., Crowe, J.P., Grobmyer, S.R. (2016). Prophylactic Risk-Reducing Surgery for Breast Cancer. In: Toi, M., Winer, E., Benson, J., Klimberg, S. (eds) Personalized Treatment of Breast Cancer. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55552-0_2

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