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Indications for Contralateral Prophylactic Mastectomy: A Consensus Statement Using Modified Delphi Methodology.

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Contralateral prophylactic mastectomy is rarely recommended for average-risk women with unilateral breast cancer. It is recommended for those with BRCA1/2 mutations or prior mantle radiation, with consideration for specific genetic mutations or symmetry concerns.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Genetics

Background:

  • Increasing rates of contralateral prophylactic mastectomy (CPM) in North American women with unilateral breast cancer necessitate consensus.
  • This study aimed to establish a nationally endorsed consensus statement for CPM using modified Delphi methodology.

Framework:

  • A nationally representative expert panel (19 general surgeons, 2 plastic surgeons, 2 medical oncologists, 2 radiation oncologists, 1 psychologist) participated.
  • Thirty-nine statements across five domains (risk factors, tumor factors, reconstruction, patient factors, miscellaneous) were developed.
  • Consensus required at least 80% agreement after two electronic rounds and an in-person meeting.

Implementation:

  • The panel did not recommend CPM for average-risk women with unilateral breast cancer.
  • CPM was recommended for patients with unilateral breast cancer and BRCA1/2 gene mutations or prior mantle field radiation.
  • Consideration for CPM was advised for women with specific genetic mutations (CHEK2, PTEN, p53, PALB2, CDH1) or significant symmetry challenges.

Implications:

  • The consensus statement provides guidance on the judicious use of CPM in unilateral breast cancer.
  • Rarely recommending CPM for average-risk individuals may help tailor treatment decisions.
  • Identifying high-risk subgroups for whom CPM is recommended or considered aids personalized oncologic care.