Predictors that Influence Contralateral Prophylactic Mastectomy Election Among Women with Ductal Carcinoma In Situ Who Were Evaluated for BRCA Genetic Testing

• Published in: Annals of surgical oncology Vol. 21; no. 11; pp. 3466 - 3472
• Main Authors: Elsayegh, Nisreen, Kuerer, Henry M., Lin, Heather, Gutierrez Barrera, Angelica M., Jackson, Michelle, Muse, Kimberly I., Litton, Jennifer K., Albarracin, Constance, Afrough, Aimaz, Hortobagyi, Gabriel N., Arun, Banu K.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-10-2014; Springer Nature B.V
• Subjects: Age Factors; BRCA1 Protein - genetics; BRCA2 Protein - genetics; Breast Neoplasms - genetics; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Breast Oncology; Carcinoma, Ductal, Breast - genetics; Carcinoma, Ductal, Breast - pathology; Carcinoma, Ductal, Breast - surgery; Carcinoma, Intraductal, Noninfiltrating - genetics; Carcinoma, Intraductal, Noninfiltrating - pathology; Carcinoma, Intraductal, Noninfiltrating - surgery; Female; Follow-Up Studies; Genetic Testing; Humans; Mastectomy; Medicine; Medicine & Public Health; Middle Aged; Mutation - genetics; Neoplasm Grading; Neoplasm Staging; Oncology; Ovarian Neoplasms - genetics; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Prognosis; Retrospective Studies; Surgery; Surgical Oncology; Contralateral Breast Cancer; BRCA Mutation; Breast Cancer; Genetic Counseling; BRCA Mutation Carrier
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-014-3747-x

Background
Patients with ductal carcinoma in situ (DCIS) are at increased risk for developing contralateral breast cancer (CBC). Consequently, more women with DCIS are electing to undergo contralateral prophylactic mastectomy (CPM). We evaluated factors associated with CPM in patients with DCIS who underwent genetic counseling for
BRCA
testing.
Methods
This retrospective study involved 165 women with DCIS referred for genetic counseling between 2003 and 2011. Patient characteristics were age, marital and educational status, tumor markers, nuclear grade, family history of breast cancer (BC) and ovarian cancer (OC), race, Ashkenazi Jewish ancestry, and
BRCA
results. Univariate and multivariate logistic regression analyses were used to determine predictive factors associated with CPM election.
Results
Of 165 patients, 44 (27 %) underwent CPM. Patients
<
45 years of age were more likely to elect CPM (
p
 = 0.0098). A
BRCA+
mutation was found in 17 patients (10.3 %), and BRCA+ women were more likely to elect CPM than BRCA or untested women (
p
 = 0.0001). Patients who had a family history of OC (57.7 %) were more likely to choose CPM than those with no family history (
p
 = 0.0004). Younger age,
BRCA
+, and an OC family history remained significant in the multivariate model (
p
 < 0.008).
Conclusion
The CPM rate among patients with DCIS who undergo genetic counseling is high. Factors associated with increased likelihood of CPM among this group were age,
BRCA
+, and a family history of OC. Further studies are needed to evaluate patients’ perceptions of CBC risk and their role in the likelihood of CPM choice.