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Risk management recommendations and patient acceptance vary with high-risk breast lesions. Am J Surg 2021; 223:94-100. [PMID: 34325908 DOI: 10.1016/j.amjsurg.2021.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/07/2021] [Accepted: 07/16/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Lobular carcinoma in situ (LCIS), atypical ductal and lobular hyperplasia (AH) increase breast cancer risk. We examined risk management recommendations (RMR) and acceptance in AH/LCIS. METHODS All patients with AH/LCIS on core needle biopsy from 2013 to 2016 at our institution were identified; cancer patients were excluded. Univariate and multivariate analysis examined factors associated with management. RESULTS 98 % of patients were evaluated by breast surgeons and 53 % underwent risk model calculation (RC). 77 % had new RMR. RMR of MRI screening (MRI), genetic counselling (GC) and medical oncology (MO) referral were 41 %, 18 %, 77 %, respectively. MRI screening was more likely recommended in those with strong family history (p = 0.01), and high RC (p < 0.001). Uptake of at least one RMR did not occur in 84 % of patients. Use of RC correlated with MO acceptance (p = 0.049). CONCLUSIONS Diagnosis of atypia has the potential to change risk management for most, however only 16 % of patients accepted all RMR.
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Su M, Huynh V, Bronsert M, Su E, Goode J, Lock A, Banden S, Ahrendt G, Afghahi A, Arruda J, Tevis S. Longitudinal Risk Management for Patients with Increased Risk for Breast Cancer. J Surg Res 2021; 266:421-429. [PMID: 34102512 DOI: 10.1016/j.jss.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/05/2021] [Accepted: 04/01/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This study aims to characterize longitudinal care management and evaluate the relationship between various patient factors and the likelihood of choosing risk-reducing behaviors in women with increased risk of developing breast cancer. METHODS A retrospective study was conducted to evaluate all adult female patients who had at least one clinic visit with a surgical provider for discussion of breast cancer risk assessment between January, 2017 to July, 2020 at an academic center. Patients with prior history of breast cancer were excluded. Patient details and strategies pursued at clinic visits were recorded. A time-to-event analysis was performed, and hazard ratios were determined to characterize associations between patient characteristics and time to pursuing risk-reducing care management. RESULTS There were 283 participants with at least one follow-up visit and 48 (17.0%) ultimately changed their initial strategy to either chemoprevention or prophylactic mastectomy. Patients with gene mutations were 6 times more likely to engage in risk-reducing management compared to those without (hazard ratio (HR) 5.99, P < 0.001). Those with histories of high-risk proliferative changes (HR 7.62, P < 0.001) and hysterectomy (HR 2.99, P = 0.019) were also more likely to engage in risk-reducing management. Age, race, and increased predicted risk of developing breast cancer (estimated by various calculators) were not associated with increased likelihood of engaging in risk-reducing strategies. CONCLUSION Known gene mutations, history of high-risk proliferative changes, and prior hysterectomy were factors associated with women who were more likely to engage in risk-reducing strategies. These findings, when paired with patient reported outcome measures, may help guide shared decision-making.
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Affiliation(s)
- Malcolm Su
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Victoria Huynh
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael Bronsert
- University of Colorado, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) and Surgical Outcomes and Applied Research (SOAR) Program, Aurora, CO, USA
| | - Erica Su
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Jennifer Goode
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Allison Lock
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Serenity Banden
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Gretchen Ahrendt
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anosheh Afghahi
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jaime Arruda
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sarah Tevis
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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Spindler N, Ebel F, Briest S, Wallochny S, Langer S. Quality of Life After Bilateral Risk-Reducing Mastectomy and Simultaneous Reconstruction Using Pre-Pectoral Silicone Implants. Patient Prefer Adherence 2021; 15:741-750. [PMID: 33880017 PMCID: PMC8053496 DOI: 10.2147/ppa.s303208] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/13/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Bilateral risk-reducing mastectomy (BRRM) can reduce the risk of developing breast cancer by up to 95% in women with increased exposure. Although survival is increased, mastectomies can adversely affect a patient physically, psychologically, and psychosexually. High health-related quality of life (HRQoL) is often achieved after simultaneous breast reconstruction (BR) following BRRM; however, data on the pre- and postoperative results of HRQoL are lacking. Therefore, we investigated the quality of life, esthetic outcome, and patient well-being after BRRM and simultaneous implant-based BR. PATIENTS AND METHODS Of the 35 patients who underwent skin-sparing or nipple-sparing mastectomy between May 2012 and December 2017 at a university hospital, only 22 completed the evaluation. Baseline data and data on previous operations and operation techniques were retrieved from the patient's charts. BREAST-Q and short form-36 health survey (SF-36) questionnaires were used to evaluate patient satisfaction and HRQoL. RESULTS SF-36 analysis showed a significantly higher score for pain (p=0.043) in our population than in the general female population. Comparing the pre- and postoperative BREAST-Q results, a significant decrease in the physical well-being of the chest (p=0.0179) and a slight improvement in breast satisfaction were observed (p=0.3266). All patients were well-satisfied with the postoperative outcome, reconstruction, and perioperative surgeon care. CONCLUSION Bilateral mastectomy with simultaneous BR using pre-pectoral implants is associated with an HRQoL similar to that of the healthy population. Although bilateral mastectomy may have an immense effect on the psychological, physical, and social aspects, immediate BR preserves the outer appearance and improves self-esteem.
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Affiliation(s)
- Nick Spindler
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
- Correspondence: Nick Spindler Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, Leipzig, 04103, GermanyTel +49-341-9717140Fax +49-341-9717139 Email
| | - Franziska Ebel
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Susanne Briest
- Department of Gynecology, Women’s and Children’s Centre, University Hospital Leipzig, Leipzig, Germany
| | - Sandra Wallochny
- Department of Gynecology, Women’s and Children’s Centre, University Hospital Leipzig, Leipzig, Germany
| | - Stefan Langer
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
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Wen H, Xu T, Huang Q, Zhang C, Zhang Q, Chen H. Nonpalpable breast masses: One-year ultrasound follow-up and morbidity outcomes in Shanghai. Medicine (Baltimore) 2020; 99:e23556. [PMID: 33327307 PMCID: PMC7738100 DOI: 10.1097/md.0000000000023556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Women with nonpalpable breast masses are at a high risk of developing breast cancer (BC) due to misdiagnosis during the follow-up period.A total of 40,334 women were divided into palpable and nonpalpable breast mass groups. We assessed the risk factors for cancer development in patients with nonpalpable breast masses during a 1-year follow-up period.Of the 1335 patients in the nonpalpable breast mass group, we found 50 patients of BC, of which 35 patients accepted surgery and were confirmed with biopsy at the beginning of the study. The remaining 15 (1.1%) were diagnosed with BC during follow-up, and included 10 in situ and 5 invasive carcinomas. Four of the 10 patients in the in situ subgroup, and 2 out of the 5 in the invasive subgroup were overweight (Body mass index > 24 kg/m). Nine in situ BC patients had breast-conserving surgery, 1 had a mastectomy. No patient in the in situ group received chemotherapy or radiotherapy. All 5 patients with invasive disease received 6 cycles of chemotherapy. Only 3 (20%) of the 15 patients with BC had a positive family history. We found 131 BC cases, including BC detected during screening (81) and follow-up (50). The incidence of BC was 240.2 per 100,000 inhabitants.Patients with nonpalpable breast masses require regular follow-up as they have a high risk of cancer occurrence. Regular follow-up can lead to early diagnosis and effective treatment of these early-stage BC patients.
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Affiliation(s)
- Hongmei Wen
- Department of General Practice, Zhangyan Community Healthcare Center
| | - Tao Xu
- Department of Health Check-Up Center, Jinshan Hospital, Fudan University, Shanghai, China
| | - Qinhua Huang
- Department of Health Check-Up Center, Jinshan Hospital, Fudan University, Shanghai, China
| | - Chumiao Zhang
- Department of Health Check-Up Center, Jinshan Hospital, Fudan University, Shanghai, China
| | - Qi Zhang
- Department of Health Check-Up Center, Jinshan Hospital, Fudan University, Shanghai, China
| | - Haiyan Chen
- Department of Health Check-Up Center, Jinshan Hospital, Fudan University, Shanghai, China
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Cen C, Chun J, Schnabel F. Management of women at increased risk for breast cancer secondary to high-risk proliferative lesions and family history of the disease. Breast J 2020; 26:1543-1548. [PMID: 32741042 DOI: 10.1111/tbj.13964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 01/10/2020] [Indexed: 12/22/2022]
Abstract
Women with breast biopsies showing high-risk proliferative lesions such as atypical hyperplasia (AH) and lobular carcinoma in situ (LCIS) have an increased risk of developing breast cancer. Other factors including age, family history of breast cancer, and extent of AH may play a role in increasing breast cancer risk. In addition to women with AH, there is a subset of women with a positive family history of breast cancer, without a known germline mutation, which places them also at an increased risk for breast cancer. Clinical management, screening, chemoprevention, and surgical risk-reduction are discussed in this review to inform the management of these high-risk women. Advanced imaging technology, pharmacologic research into different targets, and innovations in breast reconstruction are changing the way in which patients are counseled of their individual risk.
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Affiliation(s)
- Cindy Cen
- Department of Surgery, New York University Langone Health, New York, NY, USA
| | - Jennifer Chun
- Department of Surgery, New York University Langone Health, New York, NY, USA
| | - Freya Schnabel
- Department of Surgery, New York University Langone Health, New York, NY, USA
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Risk-reducing mastectomy: a case series of 124 procedures in Brazilian patients. Breast Cancer Res Treat 2020; 181:69-75. [PMID: 32215763 DOI: 10.1007/s10549-020-05582-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/20/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Women with mutations in breast cancer predisposition genes have a significantly higher lifetime risk of developing breast cancer and can opt for risk-reducing mastectomy. Women with positive family history of cancer can also opt for prophylactic surgery as a preventive method in selected cases. Current studies showed reduced risk of developing breast cancer after prophylactic nipple-sparing mastectomy, however, despite the good clinical outcomes, one of the main concerns regarding nipple-sparing mastectomy (NSM) is the oncological safety of nipple-areola complex preservation. In this study, we aimed to evaluate the indications, complication rates, and unfavorable events of 62 Brazilian patients that underwent risk-reducing NSM from 2004 to 2018. METHODS Patient data were reviewed retrospectively and descriptive statistics were utilized to summarize the findings. RESULTS The mean patients age was 43.8 years. The main indication for risk-reducing NSM was the presence of pathogenic mutation (53.3%), followed by atypia or lobular carcinoma in situ (25.8), and family history of breast cancer and/or ovarian cancer (20.9%). There were four (3.2%) incidental diagnosis of ductal carcinoma in situ and one invasive ductal carcinoma (0.8%). From the 124 prophylactic NSM performed, two (1.6%) complications had occurred: one (0.8%) infection and one (0.8%) partial nipple necrosis. In a mean follow-up of 50 months, there was one (1.6%) newly diagnosed breast cancer in the 62 patients undergoing prophylactic NSM. CONCLUSIONS Our findings demonstrated efficacy and safety to perform NSM as prophylactic surgery with good oncological outcomes and low complication rates in a case series of Brazilian patients.
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Ali Ghalib HH, Ali DH, Molah Karim SA, Mohialdeen Gubari MI, Mohammed SA, Marif DH, Othman HM. Risk factors assessment of breast cancer among Iraqi Kurdish women: Case-control study. J Family Med Prim Care 2019; 8:3990-3997. [PMID: 31879648 PMCID: PMC6924248 DOI: 10.4103/jfmpc.jfmpc_528_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To our knowledge, there is no international publication on risk factors of breast cancer among Kurdish women. There are several risk factors of breast cancer may differ in different geographical cultures. The aims of this study are to assess the established and probable risk factors of breast cancer among Iraqi Kurdish women as well as to investigate the effect of some Mediterranean food items on this issue. MATERIALS AND METHODS This retrospective case-control study was constructed in Sulaimanyah governorate-Iraq. Data were collected regarding socio-demographic characters, established risk factors, and dietary habits of 338 cases that were registered in Sulaimanyah Breast Center during January 2015-February 2019 with collection of same items for 338 age-matched controls. RESULTS The marriage was appeared to be a protective factor with (OR = 0.596, CI: 0.364-0.974, P = 0.039). Age at menarche ≥14 years has a protective effect with (OR: 0.326, P = 0.027) and 152 cases (45.0%) had menarche at ≤12 years compared to 56 controls (16.6%) with (P = 0.000). Numbers of children ≥ 3, regular exercise, and breastfeeding for >48 months duration have protective role. Consumption of fast foods and some Mediterranean foods weekly >2 times are risk factors, while taking stewed meat weekly one time, fish weekly ≥1 time, fruit daily>1 time and vegetables daily≥1 time, and black tea daily >3 cups have preventative effect on breast cancer. CONCLUSION Among Kurdish women, some items of Mediterranean food have the same causative effect as fast food items. Marriages, consumption of stewed meat, fish, fruit, vegetables, and black tea may have preventative effect.
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Affiliation(s)
- Hawar Hasan Ali Ghalib
- Consultant Breast Surgeon, Department of Surgery, College of Medicine, Sulaimani University, Kurdistan Region, Iraq
| | - Dawan Hiwa Ali
- High Diploma Candidate for Breast Diseases, Department of Breast Diseases, Breast Center of Sulaimanyah, Sulaimanyah Governorate, Kurdistan Region, Iraq
| | - Sherko Abdullah Molah Karim
- General and Digestive Surgeon, Department of Surgery, Shar Teaching Hospital, Sulaimanyah Governorate, Kurdistan Region, Iraq
| | - Mohammed Ibrahim Mohialdeen Gubari
- Department of Community Health, Technical College of Health, Sulaimani Polytechnic University, Sulaimanyah Governorate, Kurdistan Region, Iraq
| | - Saman Ahmed Mohammed
- Department of Family and Community Medicine, College of Medicine, Sulaimani University, Kurdistan Region, Iraq
| | - Diyar Hassan Marif
- Department of General Surgery, Sulaimanyah Teaching Hospital, Sulaimanyah Governorate, Kurdistan Region, Iraq
| | - Hawsar Mohammed Othman
- Department of General Surgery, Sulaimanyah Teaching Hospital, Sulaimanyah Governorate, Kurdistan Region, Iraq
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Flanagan MR, Zabor EC, Stempel M, Mangino DA, Morrow M, Pilewskie ML. Chemoprevention Uptake for Breast Cancer Risk Reduction Varies by Risk Factor. Ann Surg Oncol 2019; 26:2127-2135. [PMID: 30815800 DOI: 10.1245/s10434-019-07236-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND/OBJECTIVE The efficacy of chemoprevention for breast cancer risk reduction has been demonstrated in randomized controlled trials; however, use remains low. We sought to determine whether uptake differed by risk factors, and to identify reasons for refusal and termination. METHODS Women seen in a high-risk clinic from October 2014 to June 2017 considered eligible for chemoprevention (history of lobular carcinoma in situ, atypia, family history of breast/ovarian cancer, genetic mutation, or history of chest wall radiation) were retrospectively identified. Breast cancer risk factors were compared among those with and without chemoprevention use, and compliance was noted. RESULTS Overall, 1506 women were identified, 24% with prior/current chemoprevention use. Women ≥ 50 years of age were more likely to use chemoprevention than women < 50 years of age (28% vs. 11%, p < 0.001). Chemoprevention use by risk factor ranged from 7 to 40%. Having multiple risk factors did not increase use. Significant variation by risk factor was present among women ≥ 50 years of age (p < 0.001), but not among women < 50 years of age (p = 0.1). Among women with a documented discussion regarding chemoprevention (575/1141), fear of adverse effects was the most common refusal reason (57/156; 36%). The majority of women (61%) who initiated chemoprevention completed 5 years. CONCLUSION Chemoprevention use among women at increased risk for breast cancer remains low, with more frequent use among women ≥ 50 years of age. These data highlight the need for ongoing educational efforts and counseling, as the majority who begin therapy complete 5 years of use. Given the fear of adverse effects as well as low uptake, particularly among women < 50 years of age, alternative risk-reducing strategies are needed.
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Affiliation(s)
- Meghan R Flanagan
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily C Zabor
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Debra A Mangino
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa L Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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