Abstract P5-22-14: Assessment of risk factors in women undergoing contralateral prophylactic mastectomy after breast cancer diagnosis: Experience at an academic medical center
Authors: Drobysheva A , Butt Y , Sahoo S 
Published: February 2018

Recently, the rates of contralateral prophylactic mastectomy (CPM) have increased significantly with no clear evidence of improvement in overall survival or breast cancer (BC) specific survival. In 2016, American Society of Breast Surgeons (ASBS) provided a consensus statement regarding when CPM should be-, can be- or may be offered and when it should be discouraged. In light of new recommendations, our study aimed to review factors that influenced the choice of CPM at our institution.

Methods: This retrospective study was approved by the IRB. Patients who underwent CPM between January 2011 and May 2014 were included. Medical records were reviewed for documentation of risk factors that led to CPM. Patients were stratified into four categories based on the consensus statement. CPM “should be considered” included carriers of BRCA1/2 mutation, patients with strong FH (2 or more first degree relatives with BC) but not tested for BRCA and patients with history of mantle radiation; CPM “can be considered” included patients with intermediate FH (one first degree or multiple second/third degree relatives with BC), carriers of non-BRCA gene mutation, patients with prior history of BC and patients with strong FH but tested negative for BRCA; CPM “may be considered" included patients with psychological factors, those who denied adjuvant therapy and patients with multicentric disease in the index side. CPM “should be discouraged” included patients with advanced disease at the time of diagnosis, patients with weak FH (one second or third degree relative with BC) and patients with no significant FH or unknown FH.

Results: Between January 2011 and May 2014, CPM was performed in 261 women ranging from 24 to 83 years (mean, 50 years). The number and percentage of women in each risk group is summarized in Table.

Discussion: Based on the results, only 13% of the 261 women satisfied the criteria for when CPM "should be considered”, 38% for when CPM "can be or may be considered”, and in the remaining 49% CPM should have been discouraged. In light of the growing controversy regarding the overall benefit of CPM, it is important that the women with average-risk are well informed about the surgical risks vs. the benefits of CPM.

Summary of the risks factors associated with contralateral prophylactic mastectomy (n=261)CPM should be considered for those at significant risk of CBC (total 13%) Carriers for BRCA 1/2 mutation2911.1%Strong Family history (patient not tested for BRCA)20.8%History of mantle radiation31.1%CPM can be considered for those at lower risk of CBC (total 30.6%) Intermediate family history6023%Carriers for non-BRCA gene mutation31.1%History of prior breast carcinoma135%Strong Family history, BRCA negative41.5%CPM may be considered for other reasons (total 7.6%) Psychological factors62.3%Patient denied adjuvant chemo or radiation therapy31.1%Multicentric disease in the index breast114.2%CPM should be discouraged (48.8%) Advanced disease at diagnosis41.5%Weak family history7829.8%No family history4115.6%Unknown family history, no other significant personal history51.9%CPM: contralateral prophylactic mastectomy; CBC: contralateral breast cancer

Citation Format: Drobysheva A, Butt Y, Sahoo S. Assessment of risk factors in women undergoing contralateral prophylactic mastectomy after breast cancer diagnosis: Experience at an academic medical center [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-22-14.