Re: Population-Based Study of Contralateral Prophylactic Mastectomy and Survival Outcomes of Breast Cancer Patients
Journal of the National Cancer Institute (Impact Factor: 12.58). 09/2010; 102(17):1371-2; author reply 1372-3. DOI: 10.1093/jnci/djq298
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ABSTRACT: Breast cancers arising in the context of germline BRCA gene mutation have unique biological features that must be considered during treatment planning. Breast conserving surgery is an acceptable option in highly motivated women who are fully informed about the risks of ipsilateral breast tumor recurrence and contralateral breast cancer. Partial breast irradiation is not recommended for these women. Concurrent bilateral salpingo-oophorectomy should be considered. BRCA1-associated breast cancer may be resistant to taxanes, but appears highly sensitive to platinum agents and to PARP inhibitors. Preoperative genetic testing can be accomplished with short turn around times and does not increase patient anxiety. Inclusion of a professional genetic counselor in the management team is essential. BRCA gene mutation status is emerging as an important prognostic and predictive factor for breast cancer patients. Preoperative genetic counseling and testing is recommended for women likely to carry a BRCA gene mutation.Current Breast Cancer Reports 06/2012; 4(2). DOI:10.1007/s12609-012-0071-y
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ABSTRACT: The aim of this study was to investigate whether contralateral prophylactic mastectomy (CPM) in addition to therapeutic mastectomy (TM) is associated with a survival advantage in high-risk women with breast cancer. A total of 385 women with stage I or II breast cancer and a family history of breast cancer who underwent TM and CPM between 1971 and 1993 were evaluated and compared to 385 patients matched on age at diagnosis, tumor stage, nodal status, and year of diagnosis who underwent TM-only. Contralateral breast cancer (CBC) events and survival outcomes were compared. At a median follow-up of 17.3 years, 2 CBCs (0.5%) developed in the CPM cohort and 31 (8.1%) in the TM-only cohort, representing a 95% decreased risk of CBC (hazard ratio [HR] = 0.05, 95% confidence interval [95% CI] 0.01-0.22, P < 0.0001). One hundred twenty-eight women in the CPM group and 162 women in the TM-only group have died, resulting in 10-year overall survival estimates of 83 and 74%, respectively (HR 0.68, 95% CI 0.54-0.86, P = 0.001). This difference in overall survival persisted in multivariate analysis (HR 0.77, P = 0.03). Disease-free survival (DFS) was better in the CPM cohort than the TM-only group (HR 0.66, 95% CI 0.53-0.82, P = 0.0002) and remained significant in multivariate analysis (HR 0.67, P = 0.0005). In this retrospective cohort study, CPM was associated with decreased CBC event and improved overall survival and disease free survival.Annals of Surgical Oncology 10/2010; 17(10):2702-9. DOI:10.1245/s10434-010-1136-7 · 3.93 Impact Factor
Article: Controversies in Breast SurgeryAnnals of Surgical Oncology 10/2010; 17 Suppl 3:230-2. DOI:10.1245/s10434-010-1264-0 · 3.93 Impact Factor