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Prophylactic Mastectomy

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https://www.readbyqxmd.com/read/28340626/decision-making-for-breast-cancer-prevention-among-women-at-elevated-risk
#1
REVIEW
Tasleem J Padamsee, Celia E Wills, Lisa D Yee, Electra D Paskett
Several medical management approaches have been shown to be effective in preventing breast cancer and detecting it early among women at elevated risk: 1) prophylactic mastectomy; 2) prophylactic oophorectomy; 3) chemoprevention; and 4) enhanced screening routines. To varying extents, however, these approaches are substantially underused relative to clinical practice recommendations. This article reviews the existing research on the uptake of these prevention approaches, the characteristics of women who are likely to use various methods, and the decision-making processes that underlie the differing choices of women...
March 24, 2017: Breast Cancer Research: BCR
https://www.readbyqxmd.com/read/28335989/sentinel-lymph-node-biopsy-in-low-risk-settings
#2
Marios Konstantinos Tasoulis, Tyler Hughes, Gildy Babiera, Anees B Chagpar
BACKGROUND: Sentinel lymph node biopsy (SLNB) should be performed in patients with ductal carcinoma in situ (DCIS) undergoing mastectomy. Yet, the same logic is controversial in the setting of prophylactic mastectomy. METHODS: Surgeons were surveyed as to their practices. Statistical analyses were performed to identify associated factors. RESULTS: 238 surgeons responded to the survey. 73.1% of respondents stated they would always perform SLNB in the setting of mastectomy for DCIS, but only 6...
March 15, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28333309/positive-margin-re-excision-following-immediate-autologous-breast-reconstruction-morbidity-cosmetic-outcome-and-oncologic-significance
#3
Oscar Ochoa, Constantine Theoharis, Steven Pisano, Minas Chrysopoulo, Peter Ledoux, Gary Arishita, Chet Nastala
Background: Acquisition of negative resection margins is paramount in the surgical management of operable breast cancer. Management of positive margins following mastectomy and immediate breast reconstruction is presently poorly defined. Objectives: The present study aims at defining morbidity and cosmetic sequela of re-excision procedures aimed at clearing involved mastectomy margins in the setting of immediate autologous breast reconstruction. Oncologic outcomes are recorded...
March 17, 2017: Aesthetic Surgery Journal
https://www.readbyqxmd.com/read/28328628/unilateral-versus-bilateral-breast-reconstruction-is-less-really-more
#4
Lauren V Kuykendall, Bugra Tugertimur, Corin Agoris, Sara Bijan, Ambuj Kumar, Deniz Dayicioglu
OBJECTIVE: Over the recent years, there has been an increase in prophylactic mastectomies with an associated increase in bilateral breast reconstruction. We aimed to compare outcomes in terms of patient satisfaction with unilateral versus bilateral breast reconstruction after deep inferior epigastric perforator (DIEP) flap and implant-based reconstruction. METHODS: Patients who underwent breast reconstruction by a single surgeon between July 2011 and July 2015 were surveyed using the independently validated BREAST-Q questionnaire...
March 21, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28319433/breast-reconstruction-following-nipple-sparing-mastectomy-clinical-outcomes-and-risk-factors-related-complications
#5
Rosaria Laporta, Benedetto Longo, Michail Sorotos, Alessio Farcomeni, Caterina Patti, Maria Rosaria Mastrangeli, Corrado Rubino, Fabio Santanelli di Pompeo
BACKGROUND: The aim of this study was to investigate clinical outcomes and risk factors related complications in patients who had undergone nipple-sparing mastectomy (NSM) followed by implant-based or autologous reconstruction. METHODS: Between 2004-2014 a single-institution retrospective review was collected on NSMs reconstruction. Patient demographics, comorbidities, breast morphological factors, type and timing of radiotherapy, type of incision, reconstruction type and timing, implant volume and complications were collected...
March 20, 2017: Journal of Plastic Surgery and Hand Surgery
https://www.readbyqxmd.com/read/28293518/the-use-of-a-hyaluronic-acid-carboxymethylcellulose-membrane-as-an-adhesion-barrier-during-nipple-delay-before-nipple-preserving-mastectomy
#6
Andreas M Lamelas, Eric M Jablonka, Marco A Harmaty, Philip J Torina
The desire for nipple-preserving mastectomies has increased over the past decade as studies have proven that the procedure has comparable oncologic risk as a traditional mastectomy in both therapeutic and prophylactic cases. Partial or complete nipple necrosis is a well-known complication of this procedure with rates in the literature ranging between 1% and 9%. In high-risk patients, surgeons are performing a delay procedure before the mastectomy to help improve nipple vascularity and decrease necrosis rates...
December 2016: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28270235/-preventive-contralateral-mastectomy-despite-absence-of-gene-mutation-management-and-treatment-of-women-with-no-medical-indication
#7
L de Jong, T M A L Klem, M Groen, L B Koppert, R A Oldenburg, W W Vrijland
Recently, there has been an increase in the rate of contralateral prophylactic mastectomies (CPM) as a therapy for breast cancer. The CPM is performed to achieve a reduction in the risk of developing asecond breast cancer. However, evidence is lacking for beneficial survival outcomes after a CPM in patients without a gene mutation, and complications of surgery are inevitable. Currently there are no evidence-based clinical practice guidelines available for clinicians to decide upon the right treatment for patients without a gene mutation...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28263160/-reconstructive-breast-surgery-using-implant-and-mesh
#8
Lene Nyhøj Heidemann, Gudjon Leifur Gunnarsson, Camilla Bille, Jens Ahm Sørensen, Jørn Bo Thomsen
The demand for reconstructive surgery after therapeutic and prophylactic mastectomy is increasing. The hammock technique for breast reconstruction was introduced in 2001 and provides support for the implant using either biologically derived or synthetic mesh. The material is formed as a hammock in the lower pole of the reconstructed breast, and due to its supportive capabilities it has been found to shorten the time needed for reconstruction, decrease the risk of capsular contracture and leave a superior aesthetic result...
March 6, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28255494/juvenile-breast-hypertrophy-a-successful-breast-reduction-of-14-9-body-weight-without-recurrence-in-a-5-year-follow-up
#9
Akmal Hisham, Marzida Abd Latib, Normala Basiron
Juvenile hypertrophy of the breast (JHB) is a rare and relentless disease affecting women in the peripubertal period. We present a 13-year-old girl with massive bilateral JHB, successfully treated with a breast reduction and free nipple graft technique. A total of 7300 grams of breast tissue had been removed, accounting for 14.9% of the patient's total body weight. Prophylactic hormonal therapy was not commenced. During the 5-year follow-up period, there was no recurrence and the patient remains satisfied with the aesthetic outcome...
2017: Case Reports in Surgery
https://www.readbyqxmd.com/read/28238934/mastectomy-and-immediate-breast-reconstruction-for-cancer-in-the-elderly-a-national-cancer-data-base-study
#10
Waleed O Gibreel, Courtney N Day, Tanya L Hoskin, Judy C Boughey, Elizabeth B Habermann, Tina J Hieken
BACKGROUND: Mastectomy with immediate breast reconstruction (M+IBR) is performed increasingly for breast cancer treatment, but whether this trend extends to the growing number of women diagnosed ≥age 65 is unknown. We studied the effects of age and comorbidities on the use and outcomes of M+IBR. STUDY DESIGN: Patients undergoing mastectomy for breast cancer were ascertained from the National Cancer Database 2004-2012. Performance of M+IBR and outcomes were compared by age group (<65 versus ≥65) and other patient and tumor factors...
January 31, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28221673/breast-cancer-prevention-strategies-in-lobular-carcinoma-in-situ-a-decision-analysis
#11
Stephanie M Wong, Natasha K Stout, Rinaa S Punglia, Ipshita Prakash, Yasuaki Sagara, Mehra Golshan
BACKGROUND: Women diagnosed with lobular carcinoma in situ (LCIS) have a 3-fold to 10-fold increased risk of developing invasive breast cancer. The objective of this study was to evaluate the life expectancy (LE) and differences in survival offered by active surveillance, risk-reducing chemoprevention, and bilateral prophylactic mastectomy among women with LCIS. METHODS: A Markov simulation model was constructed to determine average LE and quality-adjusted LE (QALE) gains for hypothetical cohorts of women diagnosed with LCIS at various ages under alternative risk-reduction strategies...
February 21, 2017: Cancer
https://www.readbyqxmd.com/read/28169929/growing-use-of-contralateral-prophylactic-mastectomy-despite-no-improvement-in-long-term-survival-for-invasive-breast-cancer
#12
Stephanie M Wong, Rachel A Freedman, Yasuaki Sagara, Fatih Aydogan, William T Barry, Mehra Golshan
OBJECTIVE: To update and examine national temporal trends in contralateral prophylactic mastectomy (CPM) and determine whether survival differed for invasive breast cancer patients based on hormone receptor (HR) status and age. METHODS: We identified women diagnosed with unilateral stage I to III breast cancer between 1998 and 2012 within the Surveillance, Epidemiology, and End Results registry. We compared characteristics and temporal trends between patients undergoing breast-conserving surgery, unilateral mastectomy, and CPM...
March 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28152879/contralateral-prophylactic-mastectomy-decision-making-in-the-population-based-icancare-study-of-early-stage-breast-cancer-patients
#13
Sarah T Hawley, Kent A Griffith, Nancy K Janz, Allison W Kurian, Kevin C Ward, Ann S Hamilton, Steven J Katz, Monica Morrow
177 Background: Contralateral prophylactic mastectomy (CPM) use is increasing in women who are not at increased risk of contralateral cancer development and will experience no survival benefit from the more morbid procedure. Little is known about treatment decision-making or provider interactions. METHODS: We surveyed a weighted random sample of newly diagnosed patients with early-stage breast cancer who were treated in 2013-14, identified through the population-based SEER registries of Los Angeles and Georgia about 3 months after surgical treatment, and merged with SEER data (N=2632, RR=70%), to determine receipt of diagnostic tests and factors related to the decision about surgery (including knowledge and perceived physician recommendation)...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152694/using-a-disease-pathway-management-approach-to-improve-the-quality-of-breast-cancer-care-in-ontario
#14
Jasmin Soobrian, Ashley Tyrrell, Clement Li, Derek Muradali, Margaret F Forbes, Angelika Gollnow, Jillian Ross, Claire Holloway
109 Background: Disease Pathway Management (DPM) is used by Cancer Care Ontario (CCO) to set priorities for cancer control, plan cancer services, and improve the quality of care in Ontario by promoting standardization. The DPM approach applies a framework to examine the performance of the entire system from prevention to end of life care, and to identify any gaps within the system. In 2014, DPM began its breast cancer pathway initiative by mapping the patient journey, depicting evidence-based best practice along the breast cancer care continuum, identifying where further guidance is needed for clinical decision making, and identifying gaps in quality of care and performance measurement indicators...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28150129/psychosocial-factors-associated-with-the-uptake-of-contralateral-prophylactic-mastectomy-among-brca1-2-mutation-noncarriers-with-newly-diagnosed-breast-cancer
#15
Jada G Hamilton, Margaux C Genoff, Melissa Salerno, Kimberly Amoroso, Sherry R Boyar, Margaret Sheehan, Megan Harlan Fleischut, Beth Siegel, Angela G Arnold, Erin E Salo-Mullen, Jennifer L Hay, Kenneth Offit, Mark E Robson
PURPOSE: Women who are newly diagnosed with breast cancer may consider contralateral prophylactic mastectomy (CPM) to reduce their future risk of cancer in their unaffected breast. Pre-surgical BRCA1/2 genetic testing can provide valuable risk information to guide this choice. However, little is understood about why BRCA1/2 mutation noncarriers, who are generally not at substantially elevated risk of contralateral disease, select CPM. METHODS: We examined the uptake of CPM among breast cancer patients identified as BRCA1/2 mutation noncarriers (n = 92) as part of a larger prospective study of the impact of pre-surgical BRCA1/2 testing...
April 2017: Breast Cancer Research and Treatment
https://www.readbyqxmd.com/read/28143474/motivations-for-contralateral-prophylactic-mastectomy-as-a-function-of-socioeconomic-status
#16
Dadrie F Baptiste, Erina L MacGeorge, Maria K Venetis, Ashton Mouton, L Brooke Friley, Rebekah Pastor, Kristen Hatten, Janaka Lagoo, Susan E Clare, Monet W Bowling
BACKGROUND: Despite no demonstrated survival advantage for women at average risk of breast cancer, rates of contralateral prophylactic mastectomy (CPM) continue to increase. Research reveals women with higher socioeconomic status (SES) are more likely to select CPM. This study examines how indicators of SES, age, and disease severity affect CPM motivations. METHODS: Patients (N = 113) who underwent CPM at four Indiana University affiliated hospitals completed telephone interviews in 2013...
February 1, 2017: BMC Women's Health
https://www.readbyqxmd.com/read/28135658/an-exploration-of-australian-psychologists-role-in-assessing-women-considering-risk-reducing-or-contralateral-prophylactic-mastectomy
#17
Lucy Braude, Rebekah Laidsaar-Powell, Jemma Gilchrist, Laura Kirsten, Ilona Juraskova
OBJECTIVES: Given increasing rates of risk-reducing mastectomies (RRM) and contralateral prophylactic mastectomies (CPM), and the potentially significant psychological sequelae of this irreversible procedure, health professionals (HPs) regularly refer patients to psychologists for pre-operative assessment and support. This is the first study to provide qualitative insights from HPs into the role of psychologists who are working with women considering RRM or CPM. MATERIALS AND METHODS: 24 HPs (psychologists, surgeons, breast care nurses and genetic counsellors) experienced in treating patients before or after RRM/CPM completed semi-structured interviews (n = 15) or participated in a focus group (n = 10)...
April 2017: Breast: Official Journal of the European Society of Mastology
https://www.readbyqxmd.com/read/28107734/patient-and-medical-barriers-preclude-uptake-of-tamoxifen-preventative-therapy-in-women-with-a-strong-family-history
#18
Anita R Skandarajah, Susan Thomas, Kylie Shackleton, Laura Chin-Lenn, Geoffrey J Lindeman, G Bruce Mann
AIMS: To assess the eligibility, uptake and impediments to tamoxifen use in high-risk women attending a risk management clinic due to family history. PATIENTS AND METHODS: All patients with a germline mutation in a cancer predisposing gene or at high genetic risk (based on family history) attending a Breast and Ovarian cancer risk management clinic from February 2014 to May 2015 received both verbal and written evidence-based information on preventive therapy and were recommended to consider endocrine prevention if not contraindicated...
April 2017: Breast: Official Journal of the European Society of Mastology
https://www.readbyqxmd.com/read/28104682/out-ranking-brca1-in-mutation-carriers
#19
REVIEW
Emma Nolan, Geoffrey J Lindeman, Jane E Visvader
Beyond prophylactic mastectomy, there are currently very few options available to BRCA1 mutation carriers to help reduce their risk of developing breast cancer. An effective prevention therapy therefore remains a pressing area of need. Accumulating evidence points to amplification of the progesterone signaling axis in precancerous tissue from BRCA1 mutation carriers. Given that RANKL is an important paracrine mediator of hormonal signaling in breast tissue, there has been considerable interest in exploring a potential role for this pathway in oncogenesis...
February 1, 2017: Cancer Research
https://www.readbyqxmd.com/read/28058563/long-term-satisfaction-and-body-image-after-contralateral-prophylactic-mastectomy
#20
Chelsea Anderson, Jessica Y Islam, M Elizabeth Hodgson, Susan A Sabatino, Juan L Rodriguez, Clara N Lee, Dale P Sandler, Hazel B Nichols
BACKGROUND: Contralateral prophylactic mastectomy (CPM) rates have been increasing in the US, and although high levels of satisfaction with CPM have been reported, few studies have evaluated the long-term effects on body image, comparing CPM with breast-conserving surgery (BCS) and unilateral mastectomy (UM). METHODS: We analyzed responses from a survey of women with both a personal and family history of breast cancer who were enrolled in the Sister Study (n = 1176)...
January 5, 2017: Annals of Surgical Oncology
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