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Bilateral Prophylactic Mastectomy in Swedish Women at High Risk of Breast Cancer: A National Survey.

Arver, Brita; Isaksson, Karin; Atterhem, Hans; Baan, Annika; Bergkvist, Leif; Brandberg, Yvonne; Ehrencrona, Hans LU ; Emanuelsson, Monica; Hellborg, Henrik and Henriksson, Karin LU , et al. (2011) In Annals of Surgery 253(6). p.1147-1154
Abstract
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... (More)
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. (Less)
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Contribution to journal
publication status
published
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in
Annals of Surgery
volume
253
issue
6
pages
1147 - 1154
publisher
Lippincott Williams & Wilkins
external identifiers
  • wos:000290664100016
  • pmid:21587115
  • scopus:79957509205
ISSN
1528-1140
DOI
10.1097/SLA.0b013e318214b55a
language
English
LU publication?
yes
id
26287a09-9c12-474d-8950-70eb1830fe5b (old id 1972403)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21587115?dopt=Abstract
date added to LUP
2011-06-07 20:59:17
date last changed
2017-02-26 04:23:03
@article{26287a09-9c12-474d-8950-70eb1830fe5b,
  abstract     = {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.},
  author       = {Arver, Brita and Isaksson, Karin and Atterhem, Hans and Baan, Annika and Bergkvist, Leif and Brandberg, Yvonne and Ehrencrona, Hans and Emanuelsson, Monica and Hellborg, Henrik and Henriksson, Karin and Karlsson, Per and Loman, Niklas and Lundberg, Jonas and Ringberg, Anita and Askmalm, Marie Stenmark and Wickman, Marie and Sandelin, Kerstin},
  issn         = {1528-1140},
  language     = {eng},
  number       = {6},
  pages        = {1147--1154},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Annals of Surgery},
  title        = {Bilateral Prophylactic Mastectomy in Swedish Women at High Risk of Breast Cancer: A National Survey.},
  url          = {http://dx.doi.org/10.1097/SLA.0b013e318214b55a},
  volume       = {253},
  year         = {2011},
}