This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Heemskerk-Gerritsen, B. A. M. Articles by Seynaeve, C. Search for Related Content PubMed Articles by Heemskerk-Gerritsen, B. A. M. Articles by Seynaeve, C.

Prophylactic Mastectomy in BRCA1/2 Mutation Carriers and Women at Risk of Hereditary Breast Cancer: Long-Term Experiences at the Rotterdam Family Cancer Clinic

¹ Department of Medical Oncology, Family Cancer Clinic, Erasmus MC—Daniel den HoedCancer Center, Rotterdam, The Netherlands
² Department of Surgical Oncology, Family Cancer Clinic, Erasmus MC—Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
³ Department of Psychosocial Care, Family Cancer Clinic, Erasmus MC—Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
⁴ Department of Clinical Genetics, Erasmus MC—Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
⁵ Department of Clinical Genetics, Vrije Universiteit MC, Amsterdam, The Netherlands

Correspondence: Address correspondence and reprint requests to: Caroline Seynaeve; E-mail: c.seynaeve{at}erasmusmc.nl

Background: BRCA1/2 mutation carriers and women from a hereditary breast(/ovarian) cancer family have a highly increased risk of developing breast cancer (BC). Prophylactic mastectomy (PM) results in the greatest BC risk reduction. Long-term data on the efficacy and sequels of PM are scarce.

Methods: From 358 high-risk women (including 236 BRCA1/2 carriers) undergoing PM between 1994 and 2004, relevant data on the occurrence of BC in relation to PM, complications in relation to breast reconstruction (BR), mutation status, age at PM and preoperative imaging examination results were extracted from the medical records, and analyzed separately for women without (unaffected, n = 177) and with a BC history (affected, n = 181).

Results: No primary BCs occurred after PM (median follow-up 4.5 years). In one previously unaffected woman, metastatic BC was detected almost 4 years after PM (primary BC not found). Median age at PM was younger in unaffected women (P < .001), affected women more frequently were 50% risk carriers (P < .001). Unexpected (pre)malignant changes at PM were found in 3% of the patients (in 5 affected, and 5 unaffected women, respectively). In 49.6% of the women opting for BR one or more complications were registered, totaling 215 complications, leading to 153 surgical interventions (71%). Complications were mainly related to cosmetic outcome (36%) and capsular formation (24%).

Conclusions: The risk of developing a primary BC after PM remains low after longer follow-up. Preoperative imaging and careful histological examination is warranted because of potential unexpected (pre)malignant findings. The high complication rate after breast reconstruction mainly concerns cosmetic issues.

Key Words: BRCA1/2 • Breast cancer • Mastectomy • Prevention • Complications • Unexpected carcinomas

This article has been cited by other articles:

				E. Briasoulis, D. Ziogas, and M. Fatouros Prophylactic Surgery in the Complex Decision-Making Management of BRCA Mutation Carriers Ann. Surg. Oncol., June 1, 2008; 15(6): 1788 - 1790. [Full Text] [PDF]