Contralateral Prophylactic Mastectomy: Factors Predictive of Occult Malignancy or High-Risk Lesion and the Impact of MRI and Genetic Testing

Lillian M Erdahl; Judy C Boughey; Tanya L Hoskin; Amy C Degnim; Tina J Hieken

doi:10.1245/s10434-015-4660-7

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Contralateral Prophylactic Mastectomy: Factors Predictive of Occult Malignancy or High-Risk Lesion and the Impact of MRI and Genetic Testing

Journal article

Peer reviewed

Contralateral Prophylactic Mastectomy: Factors Predictive of Occult Malignancy or High-Risk Lesion and the Impact of MRI and Genetic Testing

Lillian M Erdahl, Judy C Boughey, Tanya L Hoskin, Amy C Degnim and Tina J Hieken

Annals of surgical oncology, Vol.23(1), pp.72-77

01/2016

DOI: 10.1245/s10434-015-4660-7

PMID: 26065870

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Abstract

Despite decreasing rates of subsequent contralateral breast cancer after diagnosis of unilateral primary breast cancer, the proportion of patients electing contralateral prophylactic mastectomy (CPM) is increasing. Our aim was to identify risk factors associated with the identification of occult malignancy (OM) or high-risk lesion (HRL) in CPM to facilitate patient counseling and operative planning. We identified patients undergoing CPM in addition to mastectomy for index breast cancer between October 2008 and June 2013. Patient and tumor factors were analyzed to identify associations with OM or HRL in CPM. Among 740 CPM patients, an OM was identified in 4.1 % and an HRL was identified in 10.5 %. On multivariable analysis, factors associated with either occult finding included older age [odds ratio (OR) 1.37, per 10-year increase], invasive lobular index tumor histology (OR 2.60), progesterone receptor (PR)-positive index tumor (OR 1.79), and neoadjuvant therapy (OR 0.55). Overall, 244 patients (33 %) underwent BRCA testing, and 38 (16 %) had a deleterious mutation; 494 patients (67 %) had a preoperative breast MRI. Neither absence of a deleterious BRCA mutation nor a negative preoperative MRI decreased the likelihood of an occult finding in CPM. Although invasive cancer was identified infrequently in CPM specimens, the rate of HRL or OM in our study was 14.6 %. Older age and infiltrating lobular and PR-positive index breast cancers were associated with a higher risk of OM in CPM, while neoadjuvant therapy diminished the risk. BRCA testing and preoperative MRI were not associated with HRL or OM. This information is valuable for patient counseling and surgical planning.

Carcinoma, Ductal, Breast - genetics

Breast Neoplasms - surgery

Neoplasms, Unknown Primary - surgery

Carcinoma, Ductal, Breast - surgery

Carcinoma, Lobular - surgery

Genetic Testing

Neoplasms, Unknown Primary - genetics

Prognosis

Follow-Up Studies

Neoplasm Invasiveness

Humans

Middle Aged

Risk Factors

Magnetic Resonance Imaging - methods

Neoplasms, Unknown Primary - diagnosis

Carcinoma, Lobular - diagnosis

Carcinoma, Ductal, Breast - diagnosis

Breast Neoplasms - genetics

Carcinoma, Lobular - genetics

Mastectomy

Female

Breast Neoplasms - diagnosis

Neoplasm Staging

Details

Title: Subtitle: Contralateral Prophylactic Mastectomy: Factors Predictive of Occult Malignancy or High-Risk Lesion and the Impact of MRI and Genetic Testing
Creators: Lillian M Erdahl - Department of Surgery, Mayo Clinic, Rochester, MN, USA
Judy C Boughey - Department of Surgery, Mayo Clinic, Rochester, MN, USA
Tanya L Hoskin - Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
Amy C Degnim - Department of Surgery, Mayo Clinic, Rochester, MN, USA
Tina J Hieken - Department of Surgery, Mayo Clinic, Rochester, MN, USA. hieken.tina@mayo.edu
Resource Type: Journal article
Publication Details: Annals of surgical oncology, Vol.23(1), pp.72-77
Publisher: United States
DOI: 10.1245/s10434-015-4660-7
PMID: 26065870
ISSN: 1068-9265
eISSN: 1534-4681
Language: English
Date published: 01/2016
Academic Unit: Surgery
Record Identifier: 9984051759902771

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