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Negative Genetic Testing Does Not Deter Contralateral Prophylactic Mastectomy in Younger Patients with Greater Family Histories of Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Increasing rates of contralateral prophylactic mastectomy (CPM) correlate with adoption of total skin-sparing mastectomy (TSSM). We aimed to characterize patients with unilateral breast cancer who underwent TSSM with CPM or without CPM (No CPM).

Methods

We reviewed all patients with unilateral breast cancer who underwent TSSM from 2006 to 2013. Trends in CPM and genetic testing were evaluated across time. Patient characteristics and complications were compared between CPM and No CPM groups.

Results

We identified 591 patients (293 No CPM and 298 CPM) with median follow-up of 25 (interquartile range [IQR] 13–52) months. All patients with deleterious mutations and 58 % of those who tested negative for mutations underwent CPM. In patients who tested negative for mutations, CPM was correlated with younger patient age, greater family history, and younger age of relatives diagnosed with breast/ovarian cancer. CPM was associated with an increased risk of superficial nipple necrosis (relative risk [RR] 2.1, 95 % confidence interval [CI] 1.12–4.0), wound breakdown (RR 1.62, 95 % CI 1.04–2.5), and infections requiring oral antibiotics (RR 1.59, 95 % CI 1.16–2.2). In patients with tissue expander/implant reconstruction, CPM was associated with an increased risk of implant exposure (RR 1.95, 95 % CI 1.03–3.7) but did not affect the risk of implant loss (RR 0.91, 95 % CI 0.56–1.48).

Conclusions

Patients who choose CPM fit the profile of patients with higher risk of contralateral breast cancer (CBC), which may be due to polygenic risk factors that are currently under investigation. Physicians should address patients’ fears of CBC, screening concerns, and the risk of complications when considering CPM.

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Disclosures

The authors have no financial interest in any of the products or devices mentioned in this article.

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Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA

    Frederick Wang MD, Hani Sbitany MD & Robert D. Foster MD

  2. Department of Surgery, Carol Franc Buck Breast Care Center, University of California, San Francisco, San Francisco, CA, USA

    Dominic Amara BA, Anne Warren Peled MD, Cheryl A. Ewing MD, Michael Alvarado MD & Laura J. Esserman MD, MBA

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  1. Frederick Wang MD
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  2. Dominic Amara BA
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  3. Anne Warren Peled MD
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  4. Hani Sbitany MD
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  6. Cheryl A. Ewing MD
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  7. Michael Alvarado MD
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  8. Laura J. Esserman MD, MBA
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Correspondence to Laura J. Esserman MD, MBA.

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Wang, F., Amara, D., Peled, A.W. et al. Negative Genetic Testing Does Not Deter Contralateral Prophylactic Mastectomy in Younger Patients with Greater Family Histories of Breast Cancer. Ann Surg Oncol 22, 3338–3345 (2015). https://doi.org/10.1245/s10434-015-4745-3

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  • DOI: https://doi.org/10.1245/s10434-015-4745-3

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