Is There an Increasing Trend of Risk-reducing Prophylactic Mastectomy Procedure in Preventing Breast Cancer Among Women?

Overview

Journal Turk J Surg

Specialty General Surgery

Date 2022 Jun 9

PMID 35677477

Authors

Bilal Arslan

Deniz Tazeoglu

Ahmet Dag

Mustafa Berkesoglu

Asena Ayca Ozdemir

Affiliations

Soon will be listed here.

Abstract

Objectives: Prophylactic contralateral/bilateral mastectomy (PCM/PBM), as a risk-reducing mastectomy procedure, has a few evidence-based indica- tions; however, there is an increasing trend in the total number of operations globally. Worldwide famous actress Angelina Jolie was detected to have BRCA-1 mutation and underwent a prophylactic bilateral mastectomy in 2013. The procedure was perceived as 'lifesaving' worldwide, which eventually led to a significant increase in BRCA gene mutation analysis and PCM/PBM. In this study, it was aimed to evaluate our risk-reducing PCM/PBM results.

Material And Methods: Twenty-seven patients underwent risk-reducing PCM/PBM between 2010-2018, but only 22 patients were included into the study. A retrospective analysis was carried out on demographics, family history, preoperative diagnoses, pathological findings, mastectomy details, reconstructive procedures, neoadjuvant chemotherapy, BRCA analysis, educational status, and mastectomy indications.

Results: Surgical indications or major reasons for surgery were as follows: BRCA-1 mutation (n= 5), BRCA-2 mutation (n= 3), malignant-like areas in magnetic resonance imaging (n= 2), lobular carcinoma in situ (n= 3) and intense anxiety (n= 9). Eighteen patients (82%) underwent an additional re- constructive procedure via implantation or autologous tissue and four patients (18%) underwent mastectomy only. PCM/PBM by years was as: 2010 (n= 1), 2011 (n= 0), 2012 (n= 1), 2013 (n= 2), 2014 (n= 1), 2015 (n= 2), 2016 (n= 3), 2017 (n= 4), 2018 (n= 8), which represents the recently increasing trend.

Conclusion: Risk-reducing PCM/PBM was performed in 59.1% of the patients (n= 13) for a significant medical reason, whereas for distress about a relapse or a new disease on the contralateral breast on the remaining 40.9% of the patients (n= 9). Evidence in the literature shows that risk-reducing mastectomy does not affect survival, although it lowers breast cancer incidence. Close surveillance, cancer screening, and chemoprevention methods should have priority.

Citing Articles

A Scoping Review of Primary Breast Cancer Risk Reduction Strategies in East and Southeast Asia.

Alpeza F, Loo C, Zhuang Q, Hartman M, Goh S, Li J Cancers (Basel). 2025; 17(2).

PMID: 39857949 PMC: 11763974. DOI: 10.3390/cancers17020168.

Pathological complete response and associated factors in breast cancer after neoadjuvant chemotherapy: A retrospective study.

Gundogdu A, Ulusahin M, Cekic A, Kazaz S, Guner A Turk J Surg. 2024; 40(1):73-81.

PMID: 39036007 PMC: 11257731. DOI: 10.47717/turkjsurg.2024.6308.

References

Nealon K, Sobti N, Gadd M, Specht M, Liao E . Assessing the additional surgical risk of contralateral prophylactic mastectomy and immediate breast implant reconstruction. Breast Cancer Res Treat. 2019; 179(2):255-265. DOI: 10.1007/s10549-019-05460-0. View

Angelos P, Bedrosian I, Euhus D, Herrmann V, Katz S, Pusic A . Contralateral Prophylactic Mastectomy: Challenging Considerations for the Surgeon. Ann Surg Oncol. 2015; 22(10):3208-12. PMC: 4836440. DOI: 10.1245/s10434-015-4758-y. View

Carbine N, Lostumbo L, Wallace J, Ko H . Risk-reducing mastectomy for the prevention of primary breast cancer. Cochrane Database Syst Rev. 2018; 4:CD002748. PMC: 6494635. DOI: 10.1002/14651858.CD002748.pub4. View

Yi M, Meric-Bernstam F, Middleton L, Arun B, Bedrosian I, Babiera G . Predictors of contralateral breast cancer in patients with unilateral breast cancer undergoing contralateral prophylactic mastectomy. Cancer. 2009; 115(5):962-71. PMC: 4365476. DOI: 10.1002/cncr.24129. View

Guillem J, Wood W, Moley J, Berchuck A, Karlan B, Mutch D . ASCO/SSO review of current role of risk-reducing surgery in common hereditary cancer syndromes. J Clin Oncol. 2006; 24(28):4642-60. DOI: 10.1200/JCO.2005.04.5260. View

Roberts M, Dusetzina S . The effect of a celebrity health disclosure on demand for health care: trends in BRCA testing and subsequent health services use. J Community Genet. 2017; 8(2):141-146. PMC: 5386917. DOI: 10.1007/s12687-017-0295-7. View

Chowdhury M, Euhus D, Onega T, Biswas S, Choudhary P . A model for individualized risk prediction of contralateral breast cancer. Breast Cancer Res Treat. 2016; 161(1):153-160. PMC: 5224985. DOI: 10.1007/s10549-016-4039-x. View

Rutgers E . Is prophylactic mastectomy justified in women without BRCA mutation?. Breast. 2019; 48 Suppl 1:S62-S64. DOI: 10.1016/S0960-9776(19)31126-9. View

Arpino G, Bardou V, Clark G, Elledge R . Infiltrating lobular carcinoma of the breast: tumor characteristics and clinical outcome. Breast Cancer Res. 2004; 6(3):R149-56. PMC: 400666. DOI: 10.1186/bcr767. View

10.

Miller M, Muhsen S, Zabor E, Flynn J, Olcese C, Giri D . Risk of Contralateral Breast Cancer in Women with Ductal Carcinoma In Situ Associated with Synchronous Ipsilateral Lobular Carcinoma In Situ. Ann Surg Oncol. 2019; 26(13):4317-4325. PMC: 6868341. DOI: 10.1245/s10434-019-07796-9. View

11.

Qin Q, Tan Q, Lian B, Mo Q, Huang Z, Wei C . Postoperative outcomes of breast reconstruction after mastectomy: A retrospective study. Medicine (Baltimore). 2018; 97(5):e9766. PMC: 5805437. DOI: 10.1097/MD.0000000000009766. View

12.

Frost M, Slezak J, Tran N, Williams C, Johnson J, Woods J . Satisfaction after contralateral prophylactic mastectomy: the significance of mastectomy type, reconstructive complications, and body appearance. J Clin Oncol. 2005; 23(31):7849-56. DOI: 10.1200/JCO.2005.09.233. View

13.

Wong S, Freedman R, Sagara Y, Aydogan F, Barry W, Golshan M . Growing Use of Contralateral Prophylactic Mastectomy Despite no Improvement in Long-term Survival for Invasive Breast Cancer. Ann Surg. 2017; 265(3):581-589. DOI: 10.1097/SLA.0000000000001698. View

14.

Reiner A, John E, Brooks J, Lynch C, Bernstein L, Mellemkjaer L . Risk of asynchronous contralateral breast cancer in noncarriers of BRCA1 and BRCA2 mutations with a family history of breast cancer: a report from the Women's Environmental Cancer and Radiation Epidemiology Study. J Clin Oncol. 2012; 31(4):433-9. PMC: 3731919. DOI: 10.1200/JCO.2012.43.2013. View

15.

Dumitrescu R . Interplay Between Genetic and Epigenetic Changes in Breast Cancer Subtypes. Methods Mol Biol. 2018; 1856:19-34. DOI: 10.1007/978-1-4939-8751-1_2. View

16.

Kruper L, Kauffmann R, Smith D, Nelson R . Survival analysis of contralateral prophylactic mastectomy: a question of selection bias. Ann Surg Oncol. 2014; 21(11):3448-56. DOI: 10.1245/s10434-014-3930-0. View

17.

Evers C, Fischer C, Dikow N, Schott S . Familial breast cancer: Genetic counseling over time, including patients´ expectations and initiators considering the Angelina Jolie effect. PLoS One. 2017; 12(5):e0177893. PMC: 5444628. DOI: 10.1371/journal.pone.0177893. View

18.

DAlonzo M, Piva E, Pecchio S, Liberale V, Modaffari P, Ponzone R . Satisfaction and Impact on Quality of Life of Clinical and Instrumental Surveillance and Prophylactic Surgery in BRCA-mutation Carriers. Clin Breast Cancer. 2018; 18(6):e1361-e1366. DOI: 10.1016/j.clbc.2018.07.015. View

19.

Liede A, Cai M, Crouter T, Niepel D, Callaghan F, Evans D . Risk-reducing mastectomy rates in the US: a closer examination of the Angelina Jolie effect. Breast Cancer Res Treat. 2018; 171(2):435-442. PMC: 6096880. DOI: 10.1007/s10549-018-4824-9. View

20.

Franceschini G, Masetti R . Bilateral risk-reducing mastectomy in BRCA mutation carriers: A difficult decision-making. Breast J. 2019; 25(3):564-565. DOI: 10.1111/tbj.13287. View