Predictors of contralateral prophylactic mastectomy in women with a BRCA1 or BRCA2 mutation: The Hereditary Breast Cancer Clinical Study Group

Kelly A. Metcalfe, Jan Lubinski, Parviz Ghadirian, Henry Lynch, Charmaine Kim-Sing, Eitan Friedman, William D. Foulkes, Susan Domchek, Peter Ainsworth, Claudine Isaacs, Nadine Tung, Jacek Gronwald, Shelly Cummings, Teresa Wagner, Siranoush Manoukian, Pål Møller, Jeffrey Weitzel, Ping Sun, Steven A. Narod

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Abstract

Purpose: To evaluate the rate of prophylactic contralateral mastectomy in an international cohort of women with hereditary breast cancer and to evaluate the predictors of uptake of preventive surgery. Patients and Methods: Women with a BRCA1 or BRCA2 mutation who had been diagnosed with unilateral breast cancer were followed prospectively for a minimum of 1.5 years. Information was collected on prophylactic surgery, tamoxifen use, and the occurrence of contralateral breast cancer. Results: Nine hundred twenty-seven women were included in the study; of these, 253 women (27.3%) underwent a contralateral prophylactic mastectomy after the initial diagnosis of breast cancer. There were large differences in uptake of contralateral prophylactic mastectomy by country, ranging from 0% in Norway to 49.3% in the United States. Among women from North America, those who had a prophylactic contralateral mastectomy were significantly younger at breast cancer diagnosis (mean age, 39 years) than were those without preventive surgery (mean age, 43 years). Women who initially underwent breast-conserving surgery were less likely to undergo contralateral prophylactic mastectomy than were women who underwent a mastectomy (12% v 40%; P <10-4). Women who had elected for a prophylactic bilateral oophorectomy were more likely to have had their contralateral breast removed than those with intact ovaries (33% v 18%; P <10-4). Conclusion: Age, type of initial breast cancer surgery, and prophylactic oophorectomy are all predictive of prophylactic contralateral mastectomy in women with breast cancer and a BRCA mutation. The acceptance of contralateral preventive mastectomy was much higher in North America than in Europe.

Original languageEnglish
Pages (from-to)1093-1097
Number of pages5
JournalJournal of Clinical Oncology
Volume26
Issue number7
DOIs
StatePublished - Mar 1 2008

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Breast Neoplasms
Mutation
Mastectomy
Ovariectomy
North America
Prophylactic Mastectomy
Clinical Studies
Segmental Mastectomy
Tamoxifen
Norway
Ovary
Breast

All Science Journal Classification (ASJC) codes

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Predictors of contralateral prophylactic mastectomy in women with a BRCA1 or BRCA2 mutation : The Hereditary Breast Cancer Clinical Study Group. / Metcalfe, Kelly A.; Lubinski, Jan; Ghadirian, Parviz; Lynch, Henry; Kim-Sing, Charmaine; Friedman, Eitan; Foulkes, William D.; Domchek, Susan; Ainsworth, Peter; Isaacs, Claudine; Tung, Nadine; Gronwald, Jacek; Cummings, Shelly; Wagner, Teresa; Manoukian, Siranoush; Møller, Pål; Weitzel, Jeffrey; Sun, Ping; Narod, Steven A.

In: Journal of Clinical Oncology, Vol. 26, No. 7, 01.03.2008, p. 1093-1097.

Research output: Contribution to journalArticle

Metcalfe, KA, Lubinski, J, Ghadirian, P, Lynch, H, Kim-Sing, C, Friedman, E, Foulkes, WD, Domchek, S, Ainsworth, P, Isaacs, C, Tung, N, Gronwald, J, Cummings, S, Wagner, T, Manoukian, S, Møller, P, Weitzel, J, Sun, P & Narod, SA 2008, 'Predictors of contralateral prophylactic mastectomy in women with a BRCA1 or BRCA2 mutation: The Hereditary Breast Cancer Clinical Study Group', Journal of Clinical Oncology, vol. 26, no. 7, pp. 1093-1097. https://doi.org/10.1200/JCO.2007.12.6078
Metcalfe, Kelly A. ; Lubinski, Jan ; Ghadirian, Parviz ; Lynch, Henry ; Kim-Sing, Charmaine ; Friedman, Eitan ; Foulkes, William D. ; Domchek, Susan ; Ainsworth, Peter ; Isaacs, Claudine ; Tung, Nadine ; Gronwald, Jacek ; Cummings, Shelly ; Wagner, Teresa ; Manoukian, Siranoush ; Møller, Pål ; Weitzel, Jeffrey ; Sun, Ping ; Narod, Steven A. / Predictors of contralateral prophylactic mastectomy in women with a BRCA1 or BRCA2 mutation : The Hereditary Breast Cancer Clinical Study Group. In: Journal of Clinical Oncology. 2008 ; Vol. 26, No. 7. pp. 1093-1097.
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abstract = "Purpose: To evaluate the rate of prophylactic contralateral mastectomy in an international cohort of women with hereditary breast cancer and to evaluate the predictors of uptake of preventive surgery. Patients and Methods: Women with a BRCA1 or BRCA2 mutation who had been diagnosed with unilateral breast cancer were followed prospectively for a minimum of 1.5 years. Information was collected on prophylactic surgery, tamoxifen use, and the occurrence of contralateral breast cancer. Results: Nine hundred twenty-seven women were included in the study; of these, 253 women (27.3{\%}) underwent a contralateral prophylactic mastectomy after the initial diagnosis of breast cancer. There were large differences in uptake of contralateral prophylactic mastectomy by country, ranging from 0{\%} in Norway to 49.3{\%} in the United States. Among women from North America, those who had a prophylactic contralateral mastectomy were significantly younger at breast cancer diagnosis (mean age, 39 years) than were those without preventive surgery (mean age, 43 years). Women who initially underwent breast-conserving surgery were less likely to undergo contralateral prophylactic mastectomy than were women who underwent a mastectomy (12{\%} v 40{\%}; P <10-4). Women who had elected for a prophylactic bilateral oophorectomy were more likely to have had their contralateral breast removed than those with intact ovaries (33{\%} v 18{\%}; P <10-4). Conclusion: Age, type of initial breast cancer surgery, and prophylactic oophorectomy are all predictive of prophylactic contralateral mastectomy in women with breast cancer and a BRCA mutation. The acceptance of contralateral preventive mastectomy was much higher in North America than in Europe.",
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T1 - Predictors of contralateral prophylactic mastectomy in women with a BRCA1 or BRCA2 mutation

T2 - The Hereditary Breast Cancer Clinical Study Group

AU - Metcalfe, Kelly A.

AU - Lubinski, Jan

AU - Ghadirian, Parviz

AU - Lynch, Henry

AU - Kim-Sing, Charmaine

AU - Friedman, Eitan

AU - Foulkes, William D.

AU - Domchek, Susan

AU - Ainsworth, Peter

AU - Isaacs, Claudine

AU - Tung, Nadine

AU - Gronwald, Jacek

AU - Cummings, Shelly

AU - Wagner, Teresa

AU - Manoukian, Siranoush

AU - Møller, Pål

AU - Weitzel, Jeffrey

AU - Sun, Ping

AU - Narod, Steven A.

PY - 2008/3/1

Y1 - 2008/3/1

N2 - Purpose: To evaluate the rate of prophylactic contralateral mastectomy in an international cohort of women with hereditary breast cancer and to evaluate the predictors of uptake of preventive surgery. Patients and Methods: Women with a BRCA1 or BRCA2 mutation who had been diagnosed with unilateral breast cancer were followed prospectively for a minimum of 1.5 years. Information was collected on prophylactic surgery, tamoxifen use, and the occurrence of contralateral breast cancer. Results: Nine hundred twenty-seven women were included in the study; of these, 253 women (27.3%) underwent a contralateral prophylactic mastectomy after the initial diagnosis of breast cancer. There were large differences in uptake of contralateral prophylactic mastectomy by country, ranging from 0% in Norway to 49.3% in the United States. Among women from North America, those who had a prophylactic contralateral mastectomy were significantly younger at breast cancer diagnosis (mean age, 39 years) than were those without preventive surgery (mean age, 43 years). Women who initially underwent breast-conserving surgery were less likely to undergo contralateral prophylactic mastectomy than were women who underwent a mastectomy (12% v 40%; P <10-4). Women who had elected for a prophylactic bilateral oophorectomy were more likely to have had their contralateral breast removed than those with intact ovaries (33% v 18%; P <10-4). Conclusion: Age, type of initial breast cancer surgery, and prophylactic oophorectomy are all predictive of prophylactic contralateral mastectomy in women with breast cancer and a BRCA mutation. The acceptance of contralateral preventive mastectomy was much higher in North America than in Europe.

AB - Purpose: To evaluate the rate of prophylactic contralateral mastectomy in an international cohort of women with hereditary breast cancer and to evaluate the predictors of uptake of preventive surgery. Patients and Methods: Women with a BRCA1 or BRCA2 mutation who had been diagnosed with unilateral breast cancer were followed prospectively for a minimum of 1.5 years. Information was collected on prophylactic surgery, tamoxifen use, and the occurrence of contralateral breast cancer. Results: Nine hundred twenty-seven women were included in the study; of these, 253 women (27.3%) underwent a contralateral prophylactic mastectomy after the initial diagnosis of breast cancer. There were large differences in uptake of contralateral prophylactic mastectomy by country, ranging from 0% in Norway to 49.3% in the United States. Among women from North America, those who had a prophylactic contralateral mastectomy were significantly younger at breast cancer diagnosis (mean age, 39 years) than were those without preventive surgery (mean age, 43 years). Women who initially underwent breast-conserving surgery were less likely to undergo contralateral prophylactic mastectomy than were women who underwent a mastectomy (12% v 40%; P <10-4). Women who had elected for a prophylactic bilateral oophorectomy were more likely to have had their contralateral breast removed than those with intact ovaries (33% v 18%; P <10-4). Conclusion: Age, type of initial breast cancer surgery, and prophylactic oophorectomy are all predictive of prophylactic contralateral mastectomy in women with breast cancer and a BRCA mutation. The acceptance of contralateral preventive mastectomy was much higher in North America than in Europe.

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