Outcomes of contralateral prophylactic mastectomy in relation to familial history: a decision analysis (BRCR-D-16-00033).

Autor: Davies KR; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Unit 1444, P.O. Box 301402, Houston, TX, 77230-1402, USA., Brewster AM; Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Bedrosian I; Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Parker PA; Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA., Crosby MA; Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Peterson SK; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Shen Y; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Volk RJ; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Unit 1444, P.O. Box 301402, Houston, TX, 77230-1402, USA., Cantor SB; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Unit 1444, P.O. Box 301402, Houston, TX, 77230-1402, USA. sbcantor@mdanderson.org.
Jazyk: angličtina
Zdroj: Breast cancer research : BCR [Breast Cancer Res] 2016 Sep 20; Vol. 18 (1), pp. 93. Date of Electronic Publication: 2016 Sep 20.
DOI: 10.1186/s13058-016-0752-y
Abstrakt: Background: Family history of breast cancer is associated with an increased risk of contralateral breast cancer (CBC) even in the absence of mutations in the breast cancer susceptibility genes BRCA1/2. We compared quality-adjusted survival after contralateral prophylactic mastectomy (CPM) with surveillance only (no CPM) among women with breast cancer incorporating the degree of family history.
Methods: We created a microsimulation model for women with first-degree, second-degree, and no family history treated for a stage I, II, or III estrogen receptor (ER)-positive or ER-negative breast cancer at the ages of 40, 50, 60, and 70. The model incorporated a 10-year posttreatment period for risk of developing CBC and/or dying of the primary cancer or CBC. For each patient profile, we used 100,000 microsimulation trials to estimate quality-adjusted life expectancy for the clinical strategies CPM and no CPM.
Results: CPM showed minimal improvement on quality-adjusted life expectancy among women age 50-60 with no or a unilateral first-degree or second-degree family history (decreasing from 0.31 to -0.06 quality-adjusted life-years (QALYs)) and was unfavorable for most subgroups of women age 70 with stage III breast cancer regardless of degree of family history (range -0.08 to -0.02 QALYs). Sensitivity analysis showed that the highest predicted benefit of CPM assuming 95 % risk reduction in CBC was 0.57 QALYs for a 40-year-old woman with stage I breast cancer who had a first-degree relative with bilateral breast cancer.
Conclusions: Women age 40 with stage I breast cancer and a first-degree relative with bilateral breast cancer have a QALY benefit from CPM similar to that reported for BRCA1/2 mutation carriers. For most subgroups of women, CPM has a minimal to no effect on quality-adjusted life expectancy, irrespective of family history of breast cancer.
Databáze: MEDLINE
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