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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2018

Open Access 01-10-2018 | Breast Oncology

Streamlining Decision Making in Contralateral Risk-Reducing Mastectomy: Impact of PREDICT and BOADICEA Computations

Authors: Tania Samantha de Silva, MSc, FRCS (Gen Surg), Victoria Rose Russell, MBBS, Francis Patrick Henry, FRCS (Plast), Paul Thomas Ryan Thiruchelvam, FRCS (Gen Surg), Dimitri John Hadjiminas, FRCS (Gen Surg), Ragheed Al-Mufti, FRCS (Gen Surg), Roselyn Katy Hogben, FRCS (Gen Surg), Judith Hunter, FRCS (Plast), Simon Wood, FRCS (Plast), Navid Jallali, FRCS (Plast), Daniel Richard Leff, MBBS, FRCS (Gen Surg), MS Oncoplastic Breast (Hons), PhD

Published in: Annals of Surgical Oncology | Issue 10/2018

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Abstract

Introduction

Patients with sporadic breast cancer (BC) have low contralateral breast cancer risk (CLBCR; approximately 0.7% per annum) and contralateral prophylactic mastectomy (CPM) offers no survival advantage. CPM with autologous reconstruction (AR) has major morbidity and resource implications.

Objective

The aim of this study was to review the impact of PREDICT survival estimates and lifetime CLBCR scores on decision making for CPM in patients with unilateral BC.

Methods

Of n = 272 consecutive patients undergoing mastectomy and AR, 252 were included. Five- and 10-year survival was computed with the PREDICT(V2) online prognostication tool, using age and clinicopathological factors. Based on family history (FH) and tumor biology, CLBCR was calculated using validated BODICEA web-based software. Survival scores were correlated against CLBCR estimates to identify patients receiving CPM with ‘low’ CLBCR (< 30% lifetime risk) and poor prognosis (5-year survival < 80%). Patients with ‘high’ CLBCR receiving unilateral mastectomy (UM) were similarly identified (UK National Institute of Health and Care Excellence [NICE] criteria for CPM, ≥ 30% lifetime BC risk). Justifications motivating CPM were investigated.

Results

Of 252 patients, 215 had UM and 37 had bilateral mastectomy and AR. Only 23 (62%) patients receiving CPM fulfilled the NICE criteria. Of 215 patients, 5 (2.3%) failed to undergo CPM despite high CLBCR and good prognosis. CPMs were performed, at the patient’s request, for no clear justification (n = 8), contralateral non-invasive disease, and/or FH (n = 5), FH alone (n = 4) and ipsilateral cancer recurrence-related anxiety (n = 3).

Conclusion

In the absence of prospective risk estimates of CLBCR and prognosis, certain patients receive CPM and reconstruction despite modest CLBCR, yet a proportion of patients with good prognoses and substantial risk are not undergoing CPM.
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Metadata
Title
Streamlining Decision Making in Contralateral Risk-Reducing Mastectomy: Impact of PREDICT and BOADICEA Computations
Authors
Tania Samantha de Silva, MSc, FRCS (Gen Surg)
Victoria Rose Russell, MBBS
Francis Patrick Henry, FRCS (Plast)
Paul Thomas Ryan Thiruchelvam, FRCS (Gen Surg)
Dimitri John Hadjiminas, FRCS (Gen Surg)
Ragheed Al-Mufti, FRCS (Gen Surg)
Roselyn Katy Hogben, FRCS (Gen Surg)
Judith Hunter, FRCS (Plast)
Simon Wood, FRCS (Plast)
Navid Jallali, FRCS (Plast)
Daniel Richard Leff, MBBS, FRCS (Gen Surg), MS Oncoplastic Breast (Hons), PhD
Publication date
01-10-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 10/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6593-4

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