Is there an increasing trend of risk-reducing prophylactic mastectomy procedure in preventing breast cancer among women?
Bilal Arslan1, Deniz Tazeoğlu1, Ahmet Dağ1, Mustafa Berkeşoğlu1, Asena Ayça Özdemir2
1Department of General Surgery, Mersin University Faculty of Medicine, Mersin, Turkey
2Department of Biostatistics, Mersin University Faculty of Medicine, Mersin, Turkey
Objective: Prophylactic contralateral/bilateral mastectomy (PCM/PBM), as a risk-reducing mastectomy procedure, has a few evidence-based indica- tions; however, there is an increasing trend in the total number of operations globally. Worldwide famous actress Angelina Jolie was detected to have BRCA-1 mutation and underwent a prophylactic bilateral mastectomy in 2013. The procedure was perceived as ‘lifesaving’ worldwide, which eventually led to a significant increase in BRCA gene mutation analysis and PCM/PBM. In this study, it was aimed to evaluate our risk-reducing PCM/PBM results.
Material and Methods: Twenty-seven patients underwent risk-reducing PCM/PBM between 2010-2018, but only 22 patients were included into the study. A retrospective analysis was carried out on demographics, family history, preoperative diagnoses, pathological findings, mastectomy details, reconstructive procedures, neoadjuvant chemotherapy, BRCA analysis, educational status, and mastectomy indications.
Results: Surgical indications or major reasons for surgery were as follows: BRCA-1 mutation (n= 5), BRCA-2 mutation (n= 3), malignant-like areas in magnetic resonance imaging (n= 2), lobular carcinoma in situ (n= 3) and intense anxiety (n= 9). Eighteen patients (82%) underwent an additional re- constructive procedure via implantation or autologous tissue and four patients (18%) underwent mastectomy only. PCM/PBM by years was as: 2010 (n= 1), 2011 (n= 0), 2012 (n= 1), 2013 (n= 2), 2014 (n= 1), 2015 (n= 2), 2016 (n= 3), 2017 (n= 4), 2018 (n= 8), which represents the recently increasing trend.
Conclusion: Risk-reducing PCM/PBM was performed in 59.1% of the patients (n= 13) for a significant medical reason, whereas for distress about a relapse or a new disease on the contralateral breast on the remaining 40.9% of the patients (n= 9). Evidence in the literature shows that risk-reducing mastectomy does not affect survival, although it lowers breast cancer incidence. Close surveillance, cancer screening, and chemoprevention methods should have priority.
Keywords: Risk-reducing mastectomy, breast cancer, BRCA1, BRCA2
This study approval was obtained from Mersin University Clinical Research Ethics Committee (Decision No: 2019-563, Date: 19.12.2019).
Concept - A.D., B.A.; Design - A.D., B.A., D.T.; Supervision - A.D., B.A., D.T.; Data Collection and/or Processing - A.A.Ö., A.D., B.A.; Analysis and/or Interpretation - B.A., A.A.Ö., A.D., D.T.; Literature Search - B.A., M.B.; Writing Manuscript - B.A., M.B., A.A.Ö.; Critical Reviews - A.D., B.A., M.B.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.