Clinical Management Factors Contribute to the Decision for Contralateral Prophylactic Mastectomy (CPM).:

Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Journal of Clinical Oncology (Impact Factor: 18.43). 04/2011; 29(16):2158-64. DOI: 10.1200/JCO.2010.29.4041
Source: PubMed


To determine whether increasing rates of contralateral prophylactic mastectomy (CPM) are due to recognition of risk factors for contralateral breast cancer (CBC) or treatment factors related to the index lesion.
From 1997 to 2005, 2,965 patients with stage 0 to III primary unilateral breast cancer underwent mastectomy at Memorial Sloan-Kettering Cancer Center. Patients who did and did not undergo CPM within 1 year of treatment for their index cancer were compared to identify independent predictors of CPM.
The rate of CPM was 13.8% (n = 407), increasing from 6.7% in 1997 to 24.2% in 2005 (P < .0001). Patients with BRCA mutations or prior mantle radiation (n = 52) accounted for 13% of those having CPM. The rate of CPM by surgeon varied from 1% to 26%. Multivariate logistic regression adjusting for surgeon-identified white race (odds ratio [OR] = 3.3), immediate reconstruction (OR = 3.3), family history of breast cancer (OR = 2.9), magnetic resonance imaging (MRI) at diagnosis (OR = 2.8), age younger than 50 years (OR = 2.2), noninvasive histology (OR = 1.8), and prior attempt at breast conversation (OR = 1.7) to be independent predictors of CPM.
These data suggest that increasing use of CPM is not associated with increased recognition of patients at high risk for CBC. Treatment factors, such as immediate reconstruction, preoperative MRI, and unsuccessful attempts at breast conservation, are associated with increased rates of CPM. Efforts to optimize breast conservation, minimize unnecessary tests, and improve patient education about the low risk of CBC may help to curb this trend.

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    • "Several studies have shown that access to immediate breast reconstruction positively affects the decision for CRRM [44] [45]. Recently, Ashfaq et al. [45] identified 102,674 patients (2004–2008) with a diagnosis of DCIS (15%) or invasive breast cancer (85%) from SEER registry data. "
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    ABSTRACT: Rates of contralateral risk-reducing mastectomy have increased substantially over the last decade. Surgical oncologists are often in the frontline, dealing with requests for this procedure. This paper reviews the current evidence base regarding contralateral breast cancer, assesses the various risk-reducing strategies, and evaluates the cost-effectiveness of contralateral risk-reducing mastectomy.
    International Journal of Surgical Oncology 01/2015; 2015:ID 901046. DOI:10.1155/2015/901046
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    • "Our findings also support the need to further investigate the role of surveillance technologies in rising rates of CPM. Although the sharp increase in rates of CPM occurred prior to widespread use of MRI in the United States (Tuttle et al., 2010), several studies have documented a link (in some cases, a predictive link) between preoperative MRI and CPM (Chung et al., 2012; King et al., 2011; Sorbero et al., 2009; Stucky et al., 2010). Although our study provides very preliminary evidence of the psychosocial impact of MRI on the decision to undergo CPM from the perspective of patients, more research is needed to understand this relationship. "
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    ABSTRACT: Rates of contralateral prophylactic mastectomy (CPM) among unilateral breast cancer patients are rapidly increasing; however, there are little data documenting the decision-making process of patients with no known BRCA mutations, who elect this more aggressive treatment. We conducted semistructured interviews with nine newly diagnosed patients who elected CPM over other surgical options. Using grounded theory, we analyzed interview data to identify influential decision-making factors by prevalence and intensity across participants. Decision-making factors included subjective evaluations of risk and benefit, avoidance of future breast cancer surveillance and accompanying worry, and desire to maintain (or improve) breast appearance. Based solely on survival benefit, the decision to undergo CPM might be viewed as unnecessary or even misguided. However, our findings show the importance of psychosocial factors in patients' assessments of risk and benefit, and support the need for additional patient-provider communication regarding these factors.
    Qualitative Health Research 11/2014; DOI:10.1177/1049732314557085 · 2.19 Impact Factor
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    • "Similarly, the rate of bilateral mastectomy has been increasing. Tuttle et al. [16] demonstrated that the use of contralateral prophylactic mastectomy among patients with unilateral breast cancer markedly increased from 1998 to 2003, rising from 4.2% in 1998 to 11.0% in 2003 and a study from Memorial SloaneKettering demonstrated that among nearly 3000 women presenting with unilateral breast cancer between 1997 and 2005, 13.8% chose contralateral prophylactic mastectomy [17]. Sorbero et al. [18] reported a nearly twotimes higher risk of contralateral prophylactic mastectomy when preoperative breast MRI was performed. "
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    ABSTRACT: Preoperative magnetic resonance imaging (MRI) is increasingly used for staging women with breast cancer, including screening for occult ipsilateral or contralateral cancer. If breast-conserving surgery is planned, a MRI examination should be performed in all ages women with suspected breast cancer, especially those exhibiting dense or heterogeneously dense breast parenchyma, for which the sensitivity of both ultrasonography and mammography is low. MRI staging causes more extensive breast surgery in a significative proportion of women by identifying additional cancer. If the ability to find additional occult cancer is the true value of MRI, this is not influenced by patients' ages. For this reason, preoperative MRI should be counseled to all women with breast cancer by clinicians, independently from the age, as the age alone does not preclude additional findings.
    International Journal of Surgery (London, England) 08/2014; 12. DOI:10.1016/j.ijsu.2014.08.383 · 1.53 Impact Factor
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