Originally published as JCO Early Release 10.1200/JCO.2007.12.6078 on January 14 2008

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Predictors of Contralateral Prophylactic Mastectomy in Women With a BRCA1 or BRCA2 Mutation: The Hereditary Breast Cancer Clinical Study Group

Kelly A. Metcalfe, Jan Lubinski, Parviz Ghadirian, Henry Lynch, Charmaine Kim-Sing, Eitan Friedman, William D. Foulkes, Susan Domchek, Peter Ainsworth, Claudine Isaacs, Nadine Tung, Jacek Gronwald, Shelly Cummings, Teresa Wagner, Siranoush Manoukian, Pål Møller, Jeffrey Weitzel, Ping Sun, Steven A. Narod

From the Lawrence Bloomberg Faculty of Nursing; Women's College Research Institute, Women's College Hospital, University of Toronto; Epidemiology Research Unit, Research Centre, Centre Hospitalier de l'Universitaire Montréal, CHUM Hôtel Dieu, Département de Nutrition, Faculte du Medicine, Toronto; London Regional Program, London Health Sciences Centre, London, Ontario; Departments of Medicine, Human Genetics, and Oncology, McGill University, Montréal, Quèbec; British Columbia Cancer Agency Vancouver, British Columbia, Canada; Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; Department of Preventive Medicine and Public Health, Creighton University School of Medicine, Omaha, NE; Suzanne Levy Gertner Oncogenetics Unit; Chaim Sheba Medical Center, Tel-Hashomer; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Departments of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA; Georgetown University Medical Center, Washington, DC; Beth Israel Deaconess Medical Centre, Boston, MA; Center for Clinical Cancer Genetics, University of Chicago, Chicago, IL; Department of Gynecology, Division of Senology, Medical University of Vienna and Private Trust for Breast Health, Vienna, Austria; Medical Genetics Service, Department of Experimental Oncology and Laboratories, Istituto Nazionale Tumori, Milan, Italy; Section for Inherited Cancer, Department of Medical Genetics, Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, Norway; and the Department of Cancer Genetics, City of Hope National Medical Center, Duarte, CA

Corresponding author: Steven A. Narod, MD, Women's College Research Institute, 790 Bay St, Room 750, Toronto, Ontario M5G 1N8; e-mail: steven.narod{at}wchospital.ca

Purpose To evaluate the rate of prophylactic contralateral mastectomy in an international cohort of women with hereditary breast cancer and to evaluate the predictors of uptake of preventive surgery.

Patients and Methods Women with a BRCA1 or BRCA2 mutation who had been diagnosed with unilateral breast cancer were followed prospectively for a minimum of 1.5 years. Information was collected on prophylactic surgery, tamoxifen use, and the occurrence of contralateral breast cancer.

Results Nine hundred twenty-seven women were included in the study; of these, 253 women (27.3%) underwent a contralateral prophylactic mastectomy after the initial diagnosis of breast cancer. There were large differences in uptake of contralateral prophylactic mastectomy by country, ranging from 0% in Norway to 49.3% in the United States. Among women from North America, those who had a prophylactic contralateral mastectomy were significantly younger at breast cancer diagnosis (mean age, 39 years) than were those without preventive surgery (mean age, 43 years). Women who initially underwent breast-conserving surgery were less likely to undergo contralateral prophylactic mastectomy than were women who underwent a mastectomy (12% v 40%; P < 10^–4). Women who had elected for a prophylactic bilateral oophorectomy were more likely to have had their contralateral breast removed than those with intact ovaries (33% v 18%; P < 10^–4).

Conclusion Age, type of initial breast cancer surgery, and prophylactic oophorectomy are all predictive of prophylactic contralateral mastectomy in women with breast cancer and a BRCA mutation. The acceptance of contralateral preventive mastectomy was much higher in North America than in Europe.

published online ahead of print at www.jco.org on January 14, 2008.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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