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Streamlining Decision Making in Contralateral Risk-Reducing Mastectomy: Impact of PREDICT and BOADICEA Computations
Tania Samantha de Silva1, Victoria Rose Russell1, Francis Patrick Henry2
1Breast Unit, Imperial College Healthcare NHS Trust, London, UK.
Annals of Surgical Oncology
|July 19, 2018
Summary
Contralateral prophylactic mastectomy (CPM) decisions for breast cancer (BC) patients are inconsistent. Many patients undergo CPM with low contralateral breast cancer risk (CLBCR), while some with high CLBCR and good prognosis do not.
Area of Science:
- Oncology
- Surgical Oncology
- Medical Decision Making
Background:
- Contralateral breast cancer risk (CLBCR) is low in sporadic breast cancer (BC) patients.
- Contralateral prophylactic mastectomy (CPM) offers no survival benefit and has significant morbidity.
- Autologous reconstruction (AR) following CPM carries substantial resource implications.
Purpose of the Study:
- To evaluate the influence of PREDICT survival estimates and CLBCR scores on CPM decisions.
- To identify patient subgroups receiving CPM or unilateral mastectomy (UM) based on risk and prognosis.
- To investigate the justifications behind CPM choices in unilateral BC.
Main Methods:
- Analysis of 252 patients undergoing mastectomy and AR.
- Utilized PREDICT(V2) for 5- and 10-year survival estimations.
- Employed BODICEA software to calculate lifetime CLBCR based on family history and tumor biology.
- Correlated survival scores with CLBCR to assess adherence to NICE criteria for CPM (≥30% lifetime risk).
Main Results:
- Only 62% of patients receiving CPM met NICE criteria for high CLBCR.
- 2.3% of patients with high CLBCR and good prognosis did not undergo CPM.
- Reasons for CPM included patient request without clear justification, contralateral non-invasive disease, family history, and anxiety regarding recurrence.
Conclusions:
- CPM decisions in unilateral BC are not consistently guided by objective risk and survival data.
- A notable proportion of patients undergo CPM despite modest CLBCR, while others with higher risk and favorable prognosis forgo the procedure.
- Improved utilization of risk stratification tools is needed to optimize CPM decision-making.
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