Prophylactic Mastectomy: still a controversial procedure?
Abstract
The follow up and care of BRCA1/2 women, and the decisions concerning risk reduction strategies, challenge the classical patient-doctor relationship. Non-directive counseling with open discussion about different alternatives for breast cancer risk reduction is usually recommended. Scientific evidence in this field is complex, due to the lack of randomized data and heterogeneous selection criteria for different studies. The physicians in charge of this follow up must be aware of the latest scientific data, to allow for an informed discussion with their patients. Decisions must be tailored taking into account individual factors. Surgical prevention (prophylactic mastectomy and/or oophorectomy) reduces the risk of invasive breast cancer in BRCA and BRCA2 patients, with prophylactic mastectomy (PM) being the most effective procedure for cancer prevention, in these women. Although effective in this setting, prophylactic surgery is still criticized because it could be non-therapeutic and only decided on the family history or clinical decision. With generalization of commercial BRCA1 and BRCA2 screening, a more accurate selection of candidates for PM is possible. Acceptance of this procedure by women at risk and health practitioners is variable. We suggest that risk management of these high-risk women must be done by multidisciplinary teams.
Keywords: breast cancer, BRCA1, BRCA2, prophylactic mastectomy.
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Roukos R H, Kappas AM, Tsianos E. Role of surgery in the prophylaxis of hereditary cancer syndromes. Ann of Surg Oncol 2002; 9: 607-609.
Hartmann LC, Schaid DJ, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med. 1999; 340:77-84.
King MC, Marks JH, Mandell JB. Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2. Science 2003; 302:643-646.
Ford D, Easton DF, Stratton M, et al. Genetic heterogeneity and penetrance analysis of the BRCA1 and BRCA2 genes in breast cancer families. The Breast Cancer Linkage Consortium. Am J Hum Genet 1998:62:678-89.
Dhar SU, Cooper HP, Wang T et al. Significant differences among physician specialties in management recommendations of BRCA1 mutation carriers. Breast Cancer Res Treat. 2011; 129 (1): 221-227.
Teller K, Kramer RK. Management of the asymptomatic BRCA mutation carrier. Appl Clin Genet 2010; 24: 121-31
Hartmann LC, Sellers TA, Schaid DJ, et al. Efficacy of bilateral prophylactic mastectomy in BRCA1 and BRCA2 gene mutation carriers. J Natl Cancer Inst. 2001;93: 1633–1637.
Meijers-Heijboer H, van Geel B, van Putten WL, et al. Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med. 2001;345(3):159–164.
Rebbeck TR, Friebel T, Lynch HT, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol. 2004;22: 1055–1062.
Kramer JL, Velasquez IA, Chen BE, et al. Prophylactic oophorectomy reduces breast cancer penetrance during prospective, long-term folow-up of BRCA1 mutation carriers. J Clin Oncol. 2005; 23:8629-8635.
Madalinska JB, Hollenstein J, Bleiker E, et al. Quality of life effects of prophylactic salpingo-oophorectomy versus gynecologic screening among women at increased risk of hereditary ovarian cancer. J Clin Oncol. 2005; 23:6890-6898.
Julian-Reynier CM, Bouchard LJ, Evans DG, et al. Women ́s attitudes toward preventive strategies for hereditary breast or ovarian carcinoma differ from one country to another: differences among English, French, and Canadian women. Cancer. 2001; 92:959-968.
Sacchini V, Pinotti JA, Barros ACSD, et al. Nipple-Sparing Mastectomy for Breast Cancer and Risk Reduction: Oncologic or Technical Problem? J Am Coll Surg. 2006; 203: 704-714.
Botkin JR, Smith KR, Croyle RT, et al. Genetic testing for a BRCA1 mutation: prophylactic surgery and screening behavior in women 2 years post testing. Am J Med Genet A. 2003; 118A(3): 201-209.
Maarse W, Jonasse Y, Ausems MG et al. First case of invasive breast cancer following prophylactic bilateral skin sparing mastectomy in a BRCA1 mutation carrier. Eur J Surg Oncol. 2009; 35:1016-1018.
Beattie MS, Crawford B, Lin F et al. Uptake, time course, and predictors of risk-reducing surgeries in BRCA carriers. Gene Test Mol Biomarkers. 2009; 13:51-56.
Lerman C, Hughes C, Croyle RT, et al. Prophylactic surgery decisions and surveillance practices one year following BRCA1/2 testing. Prev Med 2000; 31:75-80.
Meijers-Heijboer EJ, Verhoog LC, Breekelmans CT, et al. Presymptomatic DNA testing and prophylactic surgery in families with a BRCA1 or BRCA2 mutation. Lancet 2000; 355:20115-2010.
Scheuer L, Kauff N, Robson M, et al. Outcome of preventive surgery and screening for breast and ovarian cancer in BRCA mutation carriers. J Clin Oncol. 2002; 20: 1260-1268.
Barton MB, West CN, Liu IL, et al. Complications following bilateral prophylactic mastectomy. J Natl Cancer Inst Monogr 2005; 61-66.
El-Amm J, Ghanem H, Zeck J et al. A patient with metastatic breast cancer 15 years after bilateral prophylactic mastectomy and oophorec- tomy. Clinical Breast Cancer, 2012; 12: 450-453.
Frost MH, Schaid DJ, Sellers TA, et al. Long-term satisfaction and psychological and social function following bilateral prophylactic mas- tectomy. JAMA. 2000;284:319–324.
Rimmer BK, Bluman LG. The psychosocial consequences of mammography. J Nat cancer Inst Monogr. 1997: 131-138.
Kuhl CK, Schrading S, Leutner CC, et al. Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. J Clin Oncol. 2005; 23:8469-8476.
Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998; 90:1371-1388.
Gronwald J, Tung N, Foulkes WD, et al. Tamoxifen and contralateral breast cancer in BRCA1 and BRCA2 carriers: An update. Int J Cancer. 2005; 118:2281-2284
King MC, Wieand S, Hale K, et al. Tamoxifen and breast cancer incidence among women with inherited mutations in BRCA1 and BRCA2: National Surgical Adjuvant Breast and Bowel Project (NSABP-P1) Breast Cancer Prevention Trial. JAMA. 2001; 286:2251-2256.
Uyei A, Peterson SK, Erlichman J, et al. Association between Clinical Characteristics and Risk-Reduction Interventions in women who underwent BRCA1 and BRCA2 testing. Cancer 2006; 107(2745-2751).
Kurian AW, Sigal BM, Plevritis SK . Survival analysis of cancer risk reduction strategies for BRCA1/2 mutation carriers. J. Clin Oncol.2010; 28(2); 222-31.
Schrag D, Kuntz KM, Garber JE, Weeks JC. Life expectancy gains from cancer prevention strategies for women with breast cancer and BRCA1 or BRCA2 mutations. JAMA 2000;283:617-24.
Evans DGR, Susnerwala I, Dawson J, et al. Risk of breast cancer in male BRCA2 carriers. J Med Genet. 2010; 47:710-711.
Guiahi M, Gabram SG, Albain KS. Clinical factors used to support prophylactic mastectomy for a male BRCA2 mutation carrier. Surgery 2006: 139: 704-706.
Freedman BC, Keto J, Smith R. Screening Mammography in Men with BRCA Mutations: Is There a Role? The Breast Journal, 2012. 18:73–75.
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