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Journal of the American College of... Sep 2000The Society of Surgical Oncology has developed a position statement54 that lists conditions warranting consideration of prophylactic mastectomy (Table 4). It must be... (Review)
Review
The Society of Surgical Oncology has developed a position statement54 that lists conditions warranting consideration of prophylactic mastectomy (Table 4). It must be stressed that there are no absolute indications for prophylactic mastectomy. The data are limited about the efficacy of prophylactic mastectomy in humans, but recent studies suggest that it results in up to 90% reduction in the risk for breast cancer. Total mastectomy is technically a more definitive procedure, although reported series have had a predominance of patients undergoing subcutaneous, nipple-sparing procedures. Prophylactic mastectomy may improve longevity in BRCA mutation carriers, but this must be balanced against the impact on quality of life. The benefits of prophylactic mastectomy relative to chemoprevention are unclear because there are no prospective randomized studies comparing these two strategies. Contralateral prophylactic mastectomy in patients with a unilateral cancer is unlikely to improve survival, but this approach may be considered for high-risk or difficult-to-observe patients, to facilitate breast reconstruction, and for the psychologic benefits. Patients considering prophylactic mastectomy should be well informed of risk-reduction alternatives and the limitations in the efficacy and cosmetic results of the procedure.
Topics: Animals; Breast Neoplasms; Female; Genetic Predisposition to Disease; Humans; Insurance Coverage; Mastectomy; Patient Selection; Surgical Flaps
PubMed: 10989906
DOI: 10.1016/s1072-7515(00)00361-6 -
The Surgical Clinics of North America Apr 2007With availability of genetic testing and development of statistical models for risk stratification, more women are being identified as having increased risk for breast... (Review)
Review
With availability of genetic testing and development of statistical models for risk stratification, more women are being identified as having increased risk for breast cancer. A number of risk-reducing treatment options with varying efficacy exist for them, including frequent surveillance, chemoprevention, prophylactic salpingo-oophorectomy (PSO), and prophylactic mastectomy (PM). Those most likely to benefit from PM are BRCA gene carriers and those who have a strong family history of breast cancer. Prevetive PM remains controversial, however. There are no randomized controlled trials to substantiate the potential benefit or harms of PM. This article describes the high-risk women in whom PM may be considered, and summarizes data on the efficacy of PM as a treatment for the prevention of breast cancer.
Topics: Breast Neoplasms; Decision Making; Female; Genes, BRCA1; Genes, BRCA2; Heterozygote; Humans; Mastectomy; Risk Assessment; Risk Factors; Survival Rate
PubMed: 17498529
DOI: 10.1016/j.suc.2007.01.009 -
Revista Da Associacao Medica Brasileira... Jan 2018
Review
Topics: Breast Neoplasms; Evidence-Based Medicine; Female; Guideline Adherence; Humans; Prophylactic Mastectomy
PubMed: 29561933
DOI: 10.1590/1806-9282.64.01.3 -
Gland Surgery Jan 2021Contralateral prophylactic mastectomy (CPM) rates have continued to rise in the United States, impacting all stakeholders including plastic and reconstructive surgeons.... (Review)
Review
Contralateral prophylactic mastectomy (CPM) rates have continued to rise in the United States, impacting all stakeholders including plastic and reconstructive surgeons. Multiple factors may be influencing this trend, including patient decision-making characteristics, knowledge about breast cancer disease and prognosis, advances in genetic testing and enhanced imaging capabilities, sociodemographic factors, and access to specialty surgical services such as breast reconstruction. In this review, the authors shed light on the current state of CPM and summarize the literature analyzing its increasing prevalence in the United States, as well as outline future directions for study and dissemination of knowledge from providers to patients surrounding this important and complex treatment decision.
PubMed: 33634008
DOI: 10.21037/gs.2020.03.15 -
Avicenna Journal of Medicine 2018The high incidence and recurrence rate of breast cancer has influenced multiple strategies such as early detection with imaging, chemoprevention and surgical... (Review)
Review
The high incidence and recurrence rate of breast cancer has influenced multiple strategies such as early detection with imaging, chemoprevention and surgical interventions that serve as preventive measures for women at high risk. Prophylactic mastectomy is one of the growing strategies of breast cancer risk reduction that is of a special importance for breast cancer gene mutation carriers. Women with personal history of cancerous breast lesions may consider ipsilateral or contralateral mastectomy as well. Existing data showed that mastectomy effectively reduces breast cancer risk. However, careful risk estimation is necessary to wisely select individuals who will benefit from preventing breast cancer.
PubMed: 30090744
DOI: 10.4103/ajm.AJM_21_18 -
The American Surgeon Feb 2013The main indication of prophylactic mastectomy pertains to BRCA1 or BRCA2 mutation carriers. Prophylactic mastectomy includes the simple method and the subcutaneous... (Review)
Review
The main indication of prophylactic mastectomy pertains to BRCA1 or BRCA2 mutation carriers. Prophylactic mastectomy includes the simple method and the subcutaneous method. Both methods can be followed by breast plastic reconstruction either at the same time or later. This review examines key issues regarding prophylactic mastectomy: the selection of patients, its effectiveness, its limitations, convergence/divergence in existing guidelines, and future perspectives.
Topics: Breast Neoplasms; Early Detection of Cancer; Female; Genes, BRCA1; Genes, BRCA2; Genetic Markers; Humans; Mammaplasty; Mastectomy; Patient Selection; Postoperative Complications; Practice Guidelines as Topic; Risk Assessment; Treatment Outcome
PubMed: 23336662
DOI: No ID Found -
Gynecologie, Obstetrique, Fertilite &... Sep 2023
Topics: Humans; Female; Prophylactic Mastectomy; Mastectomy; Breast Neoplasms; Robotics; Mastectomy, Segmental
PubMed: 37019213
DOI: 10.1016/j.gofs.2023.03.008 -
Breast (Edinburgh, Scotland) Apr 2021The uptake of contralateral prophylactic mastectomy (CPM) has increased steadily over the last twenty years in women of all age groups and breast cancer stages. Since... (Review)
Review
The uptake of contralateral prophylactic mastectomy (CPM) has increased steadily over the last twenty years in women of all age groups and breast cancer stages. Since contralateral breast cancer is relatively rare and the breast cancer guidelines only recommend CPM in a small subset of patients with breast cancer, the drivers of this trend are unknown. This review aims to evaluate the evidence for and acceptability of CPM, data on patient rationales for choosing CPM, and some of the factors that might impact patient preferences. Based on the evidence, future recommendations will be provided. First, data on contralateral breast cancer risk and CPM rates and trends are addressed. After that, the evidence is structured around four main patient rationales for CPM formulated as questions that patients might ask their surgeon: Will CPM reduce mortality risk? Will CPM reduce the risk of contralateral breast cancer? Can I avoid future screening with CPM? Will I have better breast symmetry after CPM? Also, three different guidelines regarding CPM will be reviewed. Studies indicate a large gap between patient preferences for radical risk reduction with CPM and the current approaches recommended by important guidelines. We suggest a strategy including shared decision-making to enhance surgeons' communication with patients about contralateral breast cancer and treatment options, to empower patients in order to optimize the use of CPM incorporating accurate risk assessment and individual patient preferences.
Topics: Breast Neoplasms; Communication; Decision Making, Shared; Female; Genetic Predisposition to Disease; Humans; Mastectomy; Patient Preference; Patient Satisfaction; Prophylactic Mastectomy
PubMed: 33621798
DOI: 10.1016/j.breast.2021.02.003 -
Journal of Surgical Oncology Jan 2015Prophylactic mastectomy generally occurs in two different patient populations: (1) high-risk women without breast cancer who undergo bilateral prophylactic mastectomy... (Review)
Review
Prophylactic mastectomy generally occurs in two different patient populations: (1) high-risk women without breast cancer who undergo bilateral prophylactic mastectomy (BPM) to reduce their risk of developing breast cancer and (2) women with unilateral breast cancer who choose contralateral prophylactic mastectomy (CPM) to prevent cancer in the contralateral breast. The purpose of this article is to review the indications, outcomes, and trends in the use of BPM and CPM.
Topics: Breast Neoplasms; Female; Humans; Mastectomy; Prophylactic Surgical Procedures
PubMed: 24965368
DOI: 10.1002/jso.23695 -
Expert Review of Anticancer Therapy Mar 2020: The contralateral prophylactic mastectomy (CPM) rate in the U.S. has been steadily increasing. This is of particular concern because many women who undergo this... (Review)
Review
: The contralateral prophylactic mastectomy (CPM) rate in the U.S. has been steadily increasing. This is of particular concern because many women who undergo this procedure are candidates for breast-conserving surgery.: CPM's medical benefit is related to the risk of contralateral cancer development and whether CPM provides a survival benefit. Contralateral cancer rates have decreased, and CPM does not provide a survival benefit. Other potential benefits of the procedure may be improved quality of life; these data are reviewed. Research efforts have been undertaken to better understand the decision-making process of patients who consider, and ultimately undergo, this procedure.: Decisional traits, personal values, the desire for peace of mind, and the desire to obtain breast symmetry are important factors that drive a woman's decision to undergo CPM. Additionally, many patients lack the knowledge on how different types of breast surgery impact outcomes. To improve the shared decision-making process, a stepwise approach to address possible misconceptions, and clarify the real risks/benefits of this procedure should be utilized. A clear recommendation (for/against) should be made for every patient with newly diagnosed breast cancer who considers CPM. Communication tools to assist patients and surgeons in this process are sorely needed.
Topics: Breast Neoplasms; Communication; Decision Making; Female; Health Knowledge, Attitudes, Practice; Humans; Prophylactic Mastectomy; Quality of Life
PubMed: 32077338
DOI: 10.1080/14737140.2020.1732213