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

Journal article
Authors Brita Arver
Karin Isaksson
Hans Atterhem
Annika Baan
Leif Bergkvist
Yvonne Brandberg
Hans Ehrencrona
Monica Emanuelsson
Henrik Hellborg
Karin Henriksson
Per Karlsson
Niklas Loman
Jonas Lundberg
Anita Ringberg
Marie Stenmark Askmalm
Marie Wickman
Kerstin Sandelin
Published in Annals of surgery
Volume 253
Issue 6
Pages 1147-1154
ISSN 1528-1140
Publication year 2011
Published at Institute of Clinical Sciences, Department of Oncology
Institute of Clinical Sciences, Department of Plastic Surgery
Pages 1147-1154
Language en
Links dx.doi.org/10.1097/SLA.0b013e318214...
Subject categories Cancer and Oncology, Surgery

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.

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