Trends in Contralateral Prophylactic Mastectomies Before and After the American Society of Breast Surgeons Consensus Statement

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2024-10-19 DOI:10.1016/j.jss.2024.09.071

Britney K. He BS , Crystal D. Chu PhD, RN , Caleigh E. Smith MD , Lucie Lefbom BS, BA , Anneke Schroen MD, MPH

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引用次数: 0

Abstract

Introduction

In 2016, an American Society of Breast Surgeons (ASBrS) statement discouraged contralateral prophylactic mastectomy (CPM) in average-risk women with unilateral breast cancer. Despite evidence of no oncologic benefit and related attempts to discourage the practice, CPM remains prevalent. This study aims to assess CPM trends post-ASBrS statement and factors associated with these trends.

Methods

A retrospective cohort study of patients with primary unilateral breast cancer undergoing complete mastectomy at a single-tertiary center between January 2014 and December 2020 was performed. We assessed the proportion opting for CPM, compared pre- and post-ASBrS statement CPM rates, and examined associated patient and tumor factors. Pearson's Chi-square test, Fisher's exact test, and equal variance t-tests were used to compare subsets who underwent CPM versus those who did not.

Results

Of 605 patients, 161 (27%) underwent CPM during our study period, with the median follow-up time for all patients being 58 mo (IQR: 38 to 81). Among all patients, CPM rates ranged from 30% to 14% before the ASBrS statement and then declined from 36% to 19% after the statement. For average-risk patients (no genetic mutation), these rates ranged from 20.2% to 10.2% from 2014 to 2016 and had a steady decline from 23.2% in 2017 to 13.2% in 2020. Only two cases (1.2%) had incidental contralateral breast cancer. Patients undergoing CPM tended to be younger, more likely to have a breast cancer gene mutation, pursue reconstruction, and elect for nipple- or skin-sparing mastectomy. Recurrence and mortality events did not differ significantly. Genetic testing and pathogenic variant rates were greater among CPM patients.

Conclusions

After an initial time lag, CPM rates appear to be decreasing post-ASBrS statement, with ongoing data needed to confirm this trend. CPM rates among breast cancer gene patients align appropriately with guidelines catering to this higher risk population. Better educational tools and decision aids may impact CPM trends and facilitate shared decision-making.

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美国乳腺外科医生学会共识声明前后对侧预防性乳房切除术的趋势。

导言：2016 年，美国乳腺外科医生学会（ASBrS）发表声明，不鼓励对患单侧乳腺癌的一般风险女性进行对侧预防性乳房切除术（CPM）。尽管有证据表明这种做法对肿瘤没有益处，而且也有人试图阻止这种做法，但 CPM 仍然很盛行。本研究旨在评估 ASBrS 声明后 CPM 的趋势以及与这些趋势相关的因素：我们对 2014 年 1 月至 2020 年 12 月期间在一家三级医院接受全乳切除术的原发性单侧乳腺癌患者进行了一项回顾性队列研究。我们评估了选择 CPM 的比例，比较了 ASBrS 声明前后的 CPM 率，并研究了相关的患者和肿瘤因素。我们使用皮尔逊卡方检验、费雪精确检验和等方差 t 检验来比较接受 CPM 与未接受 CPM 的子集：在 605 名患者中，有 161 人（27%）在研究期间接受了 CPM，所有患者的中位随访时间为 58 个月（IQR：38 至 81）。在所有患者中，CPM 的比例在 ASBrS 声明之前从 30% 到 14% 不等，声明之后从 36% 下降到 19%。就平均风险患者（无基因突变）而言，2014 年至 2016 年，这些比率从 20.2% 到 10.2% 不等，并从 2017 年的 23.2% 稳步下降到 2020 年的 13.2%。只有两例（1.2%）偶发对侧乳腺癌。接受CPM的患者往往更年轻，更有可能出现乳腺癌基因突变，追求重建，并选择乳头或皮肤保留乳房切除术。复发率和死亡率没有明显差异。CPM患者的基因检测率和致病变异率更高：结论：经过最初的时间滞后，ASBrS 声明后 CPM 的发生率似乎在下降，但需要持续的数据来证实这一趋势。乳腺癌基因患者的 CPM 率与针对这一高风险人群的指南保持一致。更好的教育工具和决策辅助工具可能会影响 CPM 的趋势并促进共同决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.