Non-genetic indications for risk reducing mastectomies: Guidelines of the national college of French gynecologists and obstetricians (CNGOF)

Objective

To determine the value of performing a risk-reducing mastectomy (RRM) in the absence of a deleterious variant of a breast cancer susceptibility gene, in 4 clinical situations at risk of breast cancer.

Design

The French National College of Obstetricians and Gynecologists (CNGOF) Commission of Senology developed these recommendations. A policy of declaration and monitoring of links of interest was applied throughout the process of making the recommendations. Similarly, the development of these recommendations did not benefit from any funding from a company marketing a health product. The Commission of Senology adhered to the AGREE II (Advancing guideline development, reporting and evaluation in healthcare) criteria and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to assess the quality of the evidence on which the recommendations were based. The potential drawbacks of making recommendations in the presence of poor quality or insufficient evidence were highlighted.

Methods

8 questions on 4 topics, focusing on histological, hereditary (except identified genetic abnormality), radiological (of unrecognized cancer), and radiation (history of Hodgkin's lymphoma) risks were considered. For each situation, it was determined whether performing RRM compared with surveillance would decrease the risk of developing breast cancer and/or increase survival.

Results

The Commission of Senology synthesis and application of the GRADE method resulted in 11 recommendations, 6 with a high level of evidence (GRADE 1+/-) and 5 with a low level of evidence (GRADE 2+/-).

Conclusion

There was significant agreement among the Commission of Senology members on recommendations to improve practices for performing or not performing RRM.