Abstract
Background: In recent years women with unilateral breast cancer (BC) have been increasingly requesting contralateral or bilateral prophylactic mastectomy (PM) despite only requiring unilateral mastectomy (M) or lumpectomy (L) respectively. This trend has been observed even in women at low risk for contralateral BC, particularly among younger women.
Objective: Determine the rates of ‘unexplained’ PM (UPM) and factors associated with this choice, among a prospective cohort of newly diagnosed young women with BC at our centre.
Methods: We reviewed the records of all patients diagnosed with BC at age ≤ 40 years from Feb ‘08 to Sept ’13 at Sunnybrook who consented to have their clinical data entered in a prospective research database. Psychosocial data - HADS [Hospital Anxiety and Depression Scale] and IES [Impact of Event Scale] - were prospectively collected from all consenting women at baseline and at completion of active treatment. Among the 149 patients treated with curative intent, 43 received unilateral M, 59 L and 47 contralateral or bilateral PM. These groups were compared with respect to demographics, risk factors, use of pre-operative MRI, pathology, treatment and surgeon gender. Differences in variables between the groups were analyzed using analysis of variance for continuous variables and chi-square test for categorical variables.
Results: The mean age of all patients was 35 years old (21-40 range). Among the 47 patients who had PM, the first surgery was L for 15 (32%), unilateral M for 27 (57%) and bilateral M for 5 (11%). Twenty-four (51%) fulfilled high risk criteria (19 BRCA mutation, 4 strong family history, 1 chest radiation) and 2 (4%) had suspicious findings in the contralateral breast. The other twenty-one patients (45%) underwent UPM for "peace of mind" alone. Thirty-three (33%) of UPM patients had T3-4 tumors. There were no statistically significant differences between the UPM group and the combined M plus L groups, except for more multicentric/ multifocal disease in the UPM groups (43% vs 9% p≤0.0001).
Discussion: Fourteen percent of young women at our centre, a 1/3 with a relatively poor prognosis had UPM. Data correlating surgical choice with baseline and follow-up psychological variables will be presented. There appears to be a need for an educational/psychological intervention at the time of BC diagnosis for non-high-risk women contemplating preventive breast surgery to ensure that such a choice is truly informed.
Citation Format: Cristiane Metran Nascente, Frances Wright, Christel Helwig, Nim Li, Rodica Mandel, Alex Kiss, Ellen Warner. Prophylactic mastectomy in young women with breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-13-07.
Volume 75, Issue 9 Supplement
