Bilateral Prophylactic Mastectomy in Swedish Women at High Risk of Breast Cancer
| Autor: | Marie Stenmark Askmalm, Jonas Lundberg, Monica Emanuelsson, Anita Ringberg, Yvonne Brandberg, Niklas Loman, Hans Atterhem, Karin Isaksson, Kerstin Sandelin, Brita Arver, Henrik Hellborg, Karin M. Henriksson, Hans Ehrencrona, Annika Baan, Marie Wickman, Per Karlsson, Leif Bergkvist |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Adult
Reoperation medicine.medical_specialty medicine.medical_treatment Breast surgery Genes BRCA2 Genes BRCA1 Breast Neoplasms Risk Assessment Breast cancer Risk Factors medicine Humans Genetic Predisposition to Disease Bilateral Prophylactic Mastectomy Mastectomy Aged Sweden business.industry Incidence Cancer Middle Aged medicine.disease Surgery Health Care Surveys Adenocarcinoma Female Breast disease business Breast reconstruction |
| Zdroj: | Annals of Surgery. 253:1147-1154 |
| ISSN: | 0003-4932 |
| DOI: | 10.1097/sla.0b013e318214b55a |
| Popis: | BACKGROUND/OBJECTIVE:: This study attempted a national inventory of all bilateral prophylactic mastectomies performed in Sweden between 1995 and 2005 in high-risk women without a previous breast malignancy. The primary aim was to investigate the breast cancer incidence after surgery. Secondary aims were to describe the preoperative risk assessment, operation techniques, complications, histopathological findings, and regional differences. METHODS:: Geneticists, oncologists and surgeons performing prophylactic breast surgery were asked to identify all women eligible for inclusion in their region. The medical records were reviewed in each region and the data were analyzed centrally. The BOADICEA risk assessment model was used to calculate the number of expected/prevented breast cancers during the follow-up period. RESULTS:: A total of 223 women operated on in 8 hospitals were identified. During a mean follow-up of 6.6 years, no primary breast cancer was observed compared with 12 expected cases. However, 1 woman succumbed 9 years post mastectomy to widespread adenocarcinoma of uncertain origin. Median age at operation was 40 years. A total of 58% were BRCA1/2 mutation carriers. All but 3 women underwent breast reconstruction, 208 with implants and 12 with autologous tissue. Four small, unifocal, invasive cancers and 4 ductal carcinoma in situ were found in the mastectomy specimens. The incidence of nonbreast related complications was low (3%). Implant loss due to infection/necrosis occurred in 21 women (10%) but a majority received a new implant later. In total, 64% of the women underwent at least 1unanticipated secondary operation. CONCLUSIONS:: Bilateral prophylactic mastectomy is safe and efficacious in reducing future breast cancer in asymptomatic women at high risk. Unanticipated reoperations are common. Given the small number of patients centralization seems justified. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|