scholarly journals Contralateral prophylactic mastectomy in young women with breast cancer: a population-based analysis of predictive factors and clinical impact

2018 ◽  
Vol 25 (6) ◽  
Author(s):  
A. Bouchard-Fortier ◽  
N. N. Baxter ◽  
R. Sutradhar ◽  
K. Fernandes ◽  
X. Camacho ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Young Women ◽  
Prophylactic Mastectomy ◽  
Estrogen Receptor Status ◽  
Contralateral Prophylactic Mastectomy ◽  
Breast Conserving Surgery ◽  
Population Based ◽  
Lymph Node Status ◽  
Cancer Specific Mortality ◽  
Negative Estrogen Receptor Status

Background and Objectives Contralateral prophylactic mastectomy (cpm) has been increasingly common among women with unilateral invasive breast cancer (ibca) even though the data that support it are limited. Using a population-based cohort, the objectives of the present study were to describe factors predictive of cpm in young women (≤35 years) with ibca and to evaluate the impact of the procedure on mortality.Methods All women diagnosed during 1994–2003 and treated with cpm were identified from the Ontario Cancer Registry. Logistic regression was used to identify patient and tumour factors associated with the use of cpm. Multivariate analyses were used to assess the effect of cpm on recurrence and mortality.Results Of 614 women identified, 81 underwent cpm (13.2%). On multivariable analysis, factors associated with cpm included negative lymph node status, negative estrogen receptor status, and initial breast-conserving surgery with re-excision. At follow-up, breast cancer–specific mortality was similar for women who did and did not undergo cpm.Conclusions Use of cpm in young women with ibca (compared with non-use) was not associated improved breast cancer–specific mortality. Factors found to be predictive of cpm were negative lymph node status, negative estrogen receptor status, and initial breast-conserving surgery followed by re-excision.

Contralateral mastectomy in young women with breast cancer: A population-based analysis of predictive factors and clinical impact.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 82-82
Author(s):  
Antoine Bouchard-Fortier ◽  
Nancy N. Baxter ◽  
Kimberley Fernandes ◽  
Ximena Camacho ◽  
May Lynn Quan
Keyword(s):  
Breast Cancer ◽  
Young Women ◽  
Invasive Breast Cancer ◽  
Survival Benefit ◽  
Estrogen Receptor Status ◽  
Population Based ◽  
Lymph Node Status ◽  
P Value ◽  
Significant Survival ◽  
Contralateral Mastectomy

82 Background: Contralateral mastectomy (CM) has recently been shown to be associated with survival benefit in women with breast cancer. The objectives of the present study were to describe factors predictive of CM in young women (≤35 years old) with invasive breast cancer and evaluate its impact on survival, in a large population based cohort. Methods: All women diagnosed with invasive breast cancer aged ≤35 from 1994 – 2003 treated with mastectomy were identified from the Ontario Cancer Registry. Patient demographics, complete tumour and treatment characteristics were abstracted from primary chart review. Cox proportional hazard regression was performed to assess factors associated with performance of CM and its effect on recurrence and overall survival, performance of CM was modeled as a time varying co-variate. The models were controlled for known predictors including age, tumor size, nodal status, ER/PR, LVI, histologic grade, systemic therapy and adjuvant radiation. Results: There were 628 women identified. Of these, 101 underwent a CM (16.1%). On multivariable analysis, factors predictive of CM were negative lymph node status (HR: 1.74, 95% CI [1.052-2.872]; p-value = 0.031) and negative estrogen receptor status (HR: 2.7, 95% CI [1.314-5.736]; p-value = 0.007). After a median follow up of 11 years, no significant survival benefit was observed in women undergoing CM compared to those who did not (HR: 0.95, 95% CI [0.61-1.46], p-value = 0.80). Conclusions: Performance of CM in young women with invasive breast cancer did not result in a significant survival benefit, compared to those without CM. Factors found to be predictive of performance of CM negative lymph node status and negative estrogen receptor status. Further studies are needed to determine if a subset of young women might benefit from CM.

Breast Cancer in Young Women

2019 ◽  
Author(s):  
Lisa A Newman
Keyword(s):  
Breast Cancer ◽  
Young Women ◽  
Triple Negative ◽  
Breast Conserving Surgery ◽  
The United States ◽  
Population Based ◽  
Incidence Rates ◽  
Disease Stage ◽  
Locoregional Therapy ◽  
Key Words Breast

The perception that breast cancer in young women is a growing problem in the United States is based on the fact that young women represent a demographic that has enlarged substantially over the past few decades. Population-based data actually reveal relatively stable incidence rates for breast cancer among women in the premenopausal age range. Young women are more likely to be diagnosed with biologically aggressive phenotypes such as triple-negative and HER2/neu-overexpressing breast cancer. Outcomes are optimized by treatment plans focusing on disease stage and targeted to phenotype. Locoregional therapy for breast cancer in young women should be based on patient preferences and disease pattern (as in older patients); young women with breast cancer can be managed safely with breast-conserving surgery. This review contains 3 figures, 2 tables, and 50 references. Key Words: breast cancer, fertility, ovarian suppression, premenopausal, young women; triple negative breast cancer

Taking control of cancer: Women’s choice for mastectomy.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 11-11
Author(s):  
Andrea Marie Covelli ◽  
Nancy Baxter ◽  
Margaret Fitch ◽  
Frances Catriona Wright
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Prophylactic Mastectomy ◽  
Early Stage ◽  
Qualitative Interviews ◽  
Contralateral Prophylactic Mastectomy ◽  
Active Role ◽  
Breast Conserving Surgery ◽  
Fear Of Recurrence ◽  
Extensive Surgery

11 Background: Rates of both unilateral (UM) and contralateral prophylactic mastectomy (CPM) for early stage breast cancer (ESBC) have been increasing since 2003. Studies suggest that the increase is due to women playing an active role in decision-making. We do not know what factors are influencing the choice for more extensive surgery. Methods: To identify these factors we completed a multi-method study; conducting a systematic review of quantitative literature and qualitative interviews. Decision-making literature was identified from 5 databases and underwent thematic analysis. Purposive sampling identified women across the Toronto Area (Ontario, Canada), who were suitable candidates for breast conserving surgery (BCS) but underwent UM or CPM. Data saturation was achieved after 29 in-person interviews. Constant comparative analysis identified key concepts and themes. Results: ‘Taking control of cancer’ was the dominant theme. Literature illustrated that patients markedly overestimate risk of local recurrence, contralateral cancer and particularly, mortality. Similarly, interviews revealed that fear of breast cancer was expressed at diagnosis and drives the decision-making process. Despite surgeons discussing survival equivalence of BCS and UM, patients chose UM due to fear of recurrence and an overestimated survival advantage. Similarly, patients chose CPM to eliminate contralateral cancer and a misperceived survival benefit. Women were actively trying to Control Outcomes, as more surgery was believed to offer greater survival and therefore greater control. Conclusions: Both the literature and our interviews have illustrated that women seek UM and CPM for treatment of their ESBC to manage their fear of cancer mortality by undergoing more extensive surgery; this in turn drives mastectomy rates. It is important to understand this process so that we may improve our ability to communicate issues of importance to women and facilitate informed decision-making.

scholarly journals Local Therapy Decision-Making and Contralateral Prophylactic Mastectomy in Young Women with Early-Stage Breast Cancer

2015 ◽  
Vol 22 (12) ◽  
pp. 3809-3815 ◽  
Author(s):  
Shoshana M. Rosenberg ◽  
Karen Sepucha ◽  
Kathryn J. Ruddy ◽  
Rulla M. Tamimi ◽  
Shari Gelber ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Young Women ◽  
Prophylactic Mastectomy ◽  
Early Stage ◽  
Local Therapy ◽  
Contralateral Prophylactic Mastectomy ◽  
Early Stage Breast Cancer ◽  
Therapy Decision

Factors associated with increasing rates of contralateral prophylactic mastectomy.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 57-57
Author(s):  
Danny Yakoub ◽  
Eli Avisar ◽  
Tulay Koru-Sengul ◽  
Feng Miao ◽  
Stacey L. Tannenbaum ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Census Data ◽  
Population Distribution ◽  
Prophylactic Mastectomy ◽  
Insurance Coverage ◽  
Healthcare Delivery ◽  
Contralateral Prophylactic Mastectomy ◽  
Population Based ◽  
Disease Stage ◽  
Outcome Variable

57 Background: Contralateral prophylactic mastectomy (CPM) is an option increasingly used by women who wish to reduce their risk of breast cancer or its local recurrence. There is limited data on demographic differences among patients who choose to undergo this procedure. Methods: The population-based Florida cancer registry, Florida’s Agency for Health Care Administration (AHCA) data, and U.S. census data were linked and queried for patients diagnosed with invasive breast cancer from 1996 to 2009. The main outcome variable was the rate of CPM in those with a single unilateral cancer diagnosis. Primary predictors were race, ethnicity, socioeconomic status (SES), marital status, and insurance status. Results: The rates of CPM rose from 2% in 1996 to 4.8% in 2006 up to 8% in 2009. The population studied was 91.1% white and 7.5% black; 89.1% non-Hispanic and 10.9% Hispanic. Out of 21,608 included patients, 837 (3.9%) underwent CPM. Significantly more white than black (3.9 versus 2.8%; p < 0.001) and more Hispanic than non-Hispanic (4.5 versus 3.8%; p = 0.0909) underwent CPM. Those in the highest SES category had higher rates of CPM compared to the lowest SES category (5.3 versus 2.9%; p < 0.001). In multivariate analyses, Blacks and uninsured patients had significantly less CPM compared to whites and private patients (OR = 0.59, 95% CI 0.42- 0.83, p = 0.002) and (OR = 0.60, 95% CI 0.36- 0.98, p = 0.043), respectively. Conclusions: CPM rates are significantly increasing; these rates were significantly different among patients of different race, socioeconomic class, and insurance coverage. This observation is not accounted for by population distribution, incidence or disease stage. More in-depth study of the causes of this increase and the disparities in healthcare delivery is critically needed.

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