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Contralateral Risk-Reducing Mastectomy in Breast Cancer Patients Who Undergo Multigene Panel Testing

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

Abstract

Background

An increasing number of breast cancer patients are undergoing expanded genetic testing and are being identified as germline mutation carriers. We sought to determine rates of contralateral risk-reducing mastectomy (CRRM) in patients with various germline mutations.

Patients and Methods

All women ≥ 18 years of age with unilateral breast cancer who underwent multigene panel testing between January 1, 2014 and August 1, 2019 at our academic institution were identified. Demographic, tumor, and treatment variables were identified from the medical record. Multivariable analyses were performed to compare factors associated with performance of CRRM.

Results

We identified 1613 patients, of whom 28.1% had a pathogenic variant and 40.1% had variants of uncertain significance (VUS). Overall, 420 patients (26.0%) underwent a CRRM. On multivariable analysis, factors associated with CRRM included age < 50 years (OR 3.8, 95% CI 3.0, 5.0), race (OR 0.5, 95% CI 0.3, 0.7 and OR 0.4, 95% CI 0.2, 0.7 for Black and Asian women, respectively, versus White women), and the presence of any germline mutation or VUS (OR 13.2, 95% CI 8.7, 20.2 for BRCA1/2; OR 3.9, 95% CI 2.7, 5.8 for non-BRCA germline mutation; and OR 1.8, 95% CI 1.3, 2.6 for VUS).

Conclusions

In breast cancer patients who undergo multigene panel testing, a sizeable number of women with pathogenic non-BRCA germline findings are opting for CRRM. Given that the risk of contralateral breast cancer in women with most pathogenic mutations other than BRCA1/2 remains poorly characterized, these data have implications for risk counseling and for ascertaining the true risks of contralateral breast cancer in this population.

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Acknowledgment

The authors thank Rachel Hicklen with the MD Anderson Cancer Center Research Medical Library Literature Search Services for her assistance in the literature search for this manuscript.

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Authors and Affiliations

  1. Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Brittany L. Murphy MD, MS, Min Yi MD, PhD & Isabelle Bedrosian MD

  2. Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Banu K. Arun MD & Angelica M. Gutierrez Barrera

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  1. Brittany L. Murphy MD, MS
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  2. Min Yi MD, PhD
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  3. Banu K. Arun MD
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  4. Angelica M. Gutierrez Barrera
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  5. Isabelle Bedrosian MD
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Correspondence to Isabelle Bedrosian MD.

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Murphy, B.L., Yi, M., Arun, B.K. et al. Contralateral Risk-Reducing Mastectomy in Breast Cancer Patients Who Undergo Multigene Panel Testing. Ann Surg Oncol 27, 4613–4621 (2020). https://doi.org/10.1245/s10434-020-08889-6

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  • DOI: https://doi.org/10.1245/s10434-020-08889-6

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