Contralateral mastectomy and survival after breast cancer in carriers of BRCA1 and BRCA2 mutations: Retrospective analysis

Kelly Metcalfe, Shelley Gershman, Parviz Ghadirian, Henry T. Lynch, Carrie Snyder, Nadine Tung, Charmaine Kim-Sing, Andrea Eisen, William D. Foulkes, Barry Rosen, Ping Sun, Steven A. Narod

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Abstract

Objective To compare the survival rates of women with BRCA associated breast cancer who did and did not undergo mastectomy of the contralateral breast. Design Retrospective analysis. Setting 12 cancer genetics clinics. Participants 390 women with a family history of stage I or II breast cancer who were carriers of BRCA1 and BRCA2 mutations and initially treated with unilateral or bilateral mastectomy. 181 patients had mastectomy of the contralateral breast. Patients were followed for up to 20 years from diagnosis. Main outcome measure Death from breast cancer. Results 79 women died of breast cancer in the follow-up period (18 in the bilateral mastectomy group and 61 in the unilateral mastectomy group). The median follow-up time was 14.3 years (range 0.1-20.0 years). At 20 years the survival rate for women who had mastectomy of the contralateral breast was 88% (95% confidence interval 83% to 93%) and for those who did not was 66% (59% to 73%). In a multivariable analysis, controlling for age at diagnosis, year of diagnosis, treatment, and other prognostic features, contralateral mastectomy was associated with a 48% reduction in death from breast cancer (hazard ratio 0.52, 95% confidence interval 0.29 to 0.93; P=0.03). In a propensity score adjusted analysis of 79 matched pairs, the association was not significant (0.60, 0.34 to 1.06; P=0.08). Based on these results, we predict that of 100 women treated with contralateral mastectomy, 87 will be alive at 20 years compared with 66 of 100 women treated with unilateral mastectomy. Conclusions This study suggests that women who are positive for BRCA mutations and who are treated for stage I or II breast cancer with bilateral mastectomy are less likely to die from breast cancer than women who are treated with unilateral mastectomy. Given the small number of events in this cohort, further research is required to confirm these findings.

Original languageEnglish
Article numberg226
JournalBritish Medical Journal
Volume348
DOIs
StatePublished - Feb 11 2014

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Mastectomy
Breast Neoplasms
Mutation
Survival
Breast
Survival Rate
Confidence Intervals
Matched-Pair Analysis
Propensity Score
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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Contralateral mastectomy and survival after breast cancer in carriers of BRCA1 and BRCA2 mutations : Retrospective analysis. / Metcalfe, Kelly; Gershman, Shelley; Ghadirian, Parviz; Lynch, Henry T.; Snyder, Carrie; Tung, Nadine; Kim-Sing, Charmaine; Eisen, Andrea; Foulkes, William D.; Rosen, Barry; Sun, Ping; Narod, Steven A.

In: British Medical Journal, Vol. 348, g226, 11.02.2014.

Research output: Contribution to journalArticle

Metcalfe, K, Gershman, S, Ghadirian, P, Lynch, HT, Snyder, C, Tung, N, Kim-Sing, C, Eisen, A, Foulkes, WD, Rosen, B, Sun, P & Narod, SA 2014, 'Contralateral mastectomy and survival after breast cancer in carriers of BRCA1 and BRCA2 mutations: Retrospective analysis', British Medical Journal, vol. 348, g226. https://doi.org/10.1136/bmj.g226
Metcalfe, Kelly ; Gershman, Shelley ; Ghadirian, Parviz ; Lynch, Henry T. ; Snyder, Carrie ; Tung, Nadine ; Kim-Sing, Charmaine ; Eisen, Andrea ; Foulkes, William D. ; Rosen, Barry ; Sun, Ping ; Narod, Steven A. / Contralateral mastectomy and survival after breast cancer in carriers of BRCA1 and BRCA2 mutations : Retrospective analysis. In: British Medical Journal. 2014 ; Vol. 348.
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abstract = "Objective To compare the survival rates of women with BRCA associated breast cancer who did and did not undergo mastectomy of the contralateral breast. Design Retrospective analysis. Setting 12 cancer genetics clinics. Participants 390 women with a family history of stage I or II breast cancer who were carriers of BRCA1 and BRCA2 mutations and initially treated with unilateral or bilateral mastectomy. 181 patients had mastectomy of the contralateral breast. Patients were followed for up to 20 years from diagnosis. Main outcome measure Death from breast cancer. Results 79 women died of breast cancer in the follow-up period (18 in the bilateral mastectomy group and 61 in the unilateral mastectomy group). The median follow-up time was 14.3 years (range 0.1-20.0 years). At 20 years the survival rate for women who had mastectomy of the contralateral breast was 88{\%} (95{\%} confidence interval 83{\%} to 93{\%}) and for those who did not was 66{\%} (59{\%} to 73{\%}). In a multivariable analysis, controlling for age at diagnosis, year of diagnosis, treatment, and other prognostic features, contralateral mastectomy was associated with a 48{\%} reduction in death from breast cancer (hazard ratio 0.52, 95{\%} confidence interval 0.29 to 0.93; P=0.03). In a propensity score adjusted analysis of 79 matched pairs, the association was not significant (0.60, 0.34 to 1.06; P=0.08). Based on these results, we predict that of 100 women treated with contralateral mastectomy, 87 will be alive at 20 years compared with 66 of 100 women treated with unilateral mastectomy. Conclusions This study suggests that women who are positive for BRCA mutations and who are treated for stage I or II breast cancer with bilateral mastectomy are less likely to die from breast cancer than women who are treated with unilateral mastectomy. Given the small number of events in this cohort, further research is required to confirm these findings.",
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AU - Metcalfe, Kelly

AU - Gershman, Shelley

AU - Ghadirian, Parviz

AU - Lynch, Henry T.

AU - Snyder, Carrie

AU - Tung, Nadine

AU - Kim-Sing, Charmaine

AU - Eisen, Andrea

AU - Foulkes, William D.

AU - Rosen, Barry

AU - Sun, Ping

AU - Narod, Steven A.

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N2 - Objective To compare the survival rates of women with BRCA associated breast cancer who did and did not undergo mastectomy of the contralateral breast. Design Retrospective analysis. Setting 12 cancer genetics clinics. Participants 390 women with a family history of stage I or II breast cancer who were carriers of BRCA1 and BRCA2 mutations and initially treated with unilateral or bilateral mastectomy. 181 patients had mastectomy of the contralateral breast. Patients were followed for up to 20 years from diagnosis. Main outcome measure Death from breast cancer. Results 79 women died of breast cancer in the follow-up period (18 in the bilateral mastectomy group and 61 in the unilateral mastectomy group). The median follow-up time was 14.3 years (range 0.1-20.0 years). At 20 years the survival rate for women who had mastectomy of the contralateral breast was 88% (95% confidence interval 83% to 93%) and for those who did not was 66% (59% to 73%). In a multivariable analysis, controlling for age at diagnosis, year of diagnosis, treatment, and other prognostic features, contralateral mastectomy was associated with a 48% reduction in death from breast cancer (hazard ratio 0.52, 95% confidence interval 0.29 to 0.93; P=0.03). In a propensity score adjusted analysis of 79 matched pairs, the association was not significant (0.60, 0.34 to 1.06; P=0.08). Based on these results, we predict that of 100 women treated with contralateral mastectomy, 87 will be alive at 20 years compared with 66 of 100 women treated with unilateral mastectomy. Conclusions This study suggests that women who are positive for BRCA mutations and who are treated for stage I or II breast cancer with bilateral mastectomy are less likely to die from breast cancer than women who are treated with unilateral mastectomy. Given the small number of events in this cohort, further research is required to confirm these findings.

AB - Objective To compare the survival rates of women with BRCA associated breast cancer who did and did not undergo mastectomy of the contralateral breast. Design Retrospective analysis. Setting 12 cancer genetics clinics. Participants 390 women with a family history of stage I or II breast cancer who were carriers of BRCA1 and BRCA2 mutations and initially treated with unilateral or bilateral mastectomy. 181 patients had mastectomy of the contralateral breast. Patients were followed for up to 20 years from diagnosis. Main outcome measure Death from breast cancer. Results 79 women died of breast cancer in the follow-up period (18 in the bilateral mastectomy group and 61 in the unilateral mastectomy group). The median follow-up time was 14.3 years (range 0.1-20.0 years). At 20 years the survival rate for women who had mastectomy of the contralateral breast was 88% (95% confidence interval 83% to 93%) and for those who did not was 66% (59% to 73%). In a multivariable analysis, controlling for age at diagnosis, year of diagnosis, treatment, and other prognostic features, contralateral mastectomy was associated with a 48% reduction in death from breast cancer (hazard ratio 0.52, 95% confidence interval 0.29 to 0.93; P=0.03). In a propensity score adjusted analysis of 79 matched pairs, the association was not significant (0.60, 0.34 to 1.06; P=0.08). Based on these results, we predict that of 100 women treated with contralateral mastectomy, 87 will be alive at 20 years compared with 66 of 100 women treated with unilateral mastectomy. Conclusions This study suggests that women who are positive for BRCA mutations and who are treated for stage I or II breast cancer with bilateral mastectomy are less likely to die from breast cancer than women who are treated with unilateral mastectomy. Given the small number of events in this cohort, further research is required to confirm these findings.

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