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Contralateral mastectomy and survival after breast cancer in carriers of BRCA1 and BRCA2 mutations: retrospective analysis.

Metcalfe K, Gershman S, Ghadirian P, Lynch HT, Snyder C, Tung N, Kim-Sing C, Eisen A, Foulkes WD, Rosen B, Sun P, Narod SA - BMJ (2014)

Bottom Line: In a propensity score adjusted analysis of 79 matched pairs, the association was not significant (0.60, 0.34 to 1.06; P=0.08).Based on these results, we predict that of 100 women treated with contralateral mastectomy, 87 will be alive at 20 years compared with 66 of 100 women treated with unilateral mastectomy.Given the small number of events in this cohort, further research is required to confirm these findings.

View Article: PubMed Central - PubMed

Affiliation: Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Canada.

ABSTRACT

Objective: To compare the survival rates of women with BRCA associated breast cancer who did and did not undergo mastectomy of the contralateral breast.

Design: Retrospective analysis.

Setting: 12 cancer genetics clinics.

Participants: 390 women with a family history of stage I or II breast cancer who were carriers of BRCA1 and BRCA2 mutations and initially treated with unilateral or bilateral mastectomy. 181 patients had mastectomy of the contralateral breast. Patients were followed for up to 20 years from diagnosis.

Main outcome measure: Death from breast cancer.

Results: 79 women died of breast cancer in the follow-up period (18 in the bilateral mastectomy group and 61 in the unilateral mastectomy group). The median follow-up time was 14.3 years (range 0.1-20.0 years). At 20 years the survival rate for women who had mastectomy of the contralateral breast was 88% (95% confidence interval 83% to 93%) and for those who did not was 66% (59% to 73%). In a multivariable analysis, controlling for age at diagnosis, year of diagnosis, treatment, and other prognostic features, contralateral mastectomy was associated with a 48% reduction in death from breast cancer (hazard ratio 0.52, 95% confidence interval 0.29 to 0.93; P=0.03). In a propensity score adjusted analysis of 79 matched pairs, the association was not significant (0.60, 0.34 to 1.06; P=0.08). Based on these results, we predict that of 100 women treated with contralateral mastectomy, 87 will be alive at 20 years compared with 66 of 100 women treated with unilateral mastectomy.

Conclusions: This study suggests that women who are positive for BRCA mutations and who are treated for stage I or II breast cancer with bilateral mastectomy are less likely to die from breast cancer than women who are treated with unilateral mastectomy. Given the small number of events in this cohort, further research is required to confirm these findings.

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Related in: MedlinePlus

Fig 1 Flow of participants through study
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fig1: Fig 1 Flow of participants through study

Mentions: We identified 615 families, totalling 1773 cases of breast cancer (fig 1). Of these 1773 cases of breast cancer, we excluded 417 women because their diagnosis was before 1975 and 70 women because they were aged more than 65 at diagnosis. An additional 29 women were known not to carry the familial mutation and were therefore excluded, along with 19 women because they had a diagnosis of other cancer before breast cancer and 26 women because they were treated outside of North America.


Contralateral mastectomy and survival after breast cancer in carriers of BRCA1 and BRCA2 mutations: retrospective analysis.

Metcalfe K, Gershman S, Ghadirian P, Lynch HT, Snyder C, Tung N, Kim-Sing C, Eisen A, Foulkes WD, Rosen B, Sun P, Narod SA - BMJ (2014)

Fig 1 Flow of participants through study
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921438&req=5

fig1: Fig 1 Flow of participants through study
Mentions: We identified 615 families, totalling 1773 cases of breast cancer (fig 1). Of these 1773 cases of breast cancer, we excluded 417 women because their diagnosis was before 1975 and 70 women because they were aged more than 65 at diagnosis. An additional 29 women were known not to carry the familial mutation and were therefore excluded, along with 19 women because they had a diagnosis of other cancer before breast cancer and 26 women because they were treated outside of North America.

Bottom Line: In a propensity score adjusted analysis of 79 matched pairs, the association was not significant (0.60, 0.34 to 1.06; P=0.08).Based on these results, we predict that of 100 women treated with contralateral mastectomy, 87 will be alive at 20 years compared with 66 of 100 women treated with unilateral mastectomy.Given the small number of events in this cohort, further research is required to confirm these findings.

View Article: PubMed Central - PubMed

Affiliation: Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Canada.

ABSTRACT

Objective: To compare the survival rates of women with BRCA associated breast cancer who did and did not undergo mastectomy of the contralateral breast.

Design: Retrospective analysis.

Setting: 12 cancer genetics clinics.

Participants: 390 women with a family history of stage I or II breast cancer who were carriers of BRCA1 and BRCA2 mutations and initially treated with unilateral or bilateral mastectomy. 181 patients had mastectomy of the contralateral breast. Patients were followed for up to 20 years from diagnosis.

Main outcome measure: Death from breast cancer.

Results: 79 women died of breast cancer in the follow-up period (18 in the bilateral mastectomy group and 61 in the unilateral mastectomy group). The median follow-up time was 14.3 years (range 0.1-20.0 years). At 20 years the survival rate for women who had mastectomy of the contralateral breast was 88% (95% confidence interval 83% to 93%) and for those who did not was 66% (59% to 73%). In a multivariable analysis, controlling for age at diagnosis, year of diagnosis, treatment, and other prognostic features, contralateral mastectomy was associated with a 48% reduction in death from breast cancer (hazard ratio 0.52, 95% confidence interval 0.29 to 0.93; P=0.03). In a propensity score adjusted analysis of 79 matched pairs, the association was not significant (0.60, 0.34 to 1.06; P=0.08). Based on these results, we predict that of 100 women treated with contralateral mastectomy, 87 will be alive at 20 years compared with 66 of 100 women treated with unilateral mastectomy.

Conclusions: This study suggests that women who are positive for BRCA mutations and who are treated for stage I or II breast cancer with bilateral mastectomy are less likely to die from breast cancer than women who are treated with unilateral mastectomy. Given the small number of events in this cohort, further research is required to confirm these findings.

Show MeSH
Related in: MedlinePlus