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The Manchester guidelines for contralateral risk-reducing mastectomy.

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A new protocol helps surgeons counsel women considering contralateral risk-reducing mastectomy (CRRM). It stratifies patients by breast cancer risk, guiding evidence-based recommendations for this complex decision.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Genetics

Background:

  • Rising rates of contralateral risk-reducing mastectomy (CRRM) contrast with decreasing contralateral breast cancer incidence.
  • Surgeons exhibit variable practices in CRRM recommendations.
  • Existing protocols lack comprehensive risk stratification for CRRM.

Purpose of the Study:

  • To develop a standardized protocol for evaluating patients considering CRRM.
  • To provide evidence-based guidelines for CRRM decision-making.
  • To address the complexity of patient motivations for CRRM.

Main Methods:

  • Systematic literature review on contralateral breast cancer risk factors.
  • National UK survey of surgical practices.
  • Development of a 5-step CRRM assessment protocol.
  • Multi-disciplinary team (MDT) formulation of guidelines.

Main Results:

  • A novel formula for calculating lifetime contralateral breast cancer risk was devised.
  • Patients are stratified into low, above average, moderate, and high-risk groups.
  • Risk stratification enables tailored recommendations for CRRM.

Conclusions:

  • The developed guidelines offer a valuable tool for clinicians counseling women on CRRM.
  • Mandatory risk assessment is crucial for patients requesting CRRM.
  • The new formula supports evidence-based recommendations in CRRM consultations.