Introduction.
Patients with sporadic breast cancer (BC)
have low contralateral breast cancer risk (CLBCR;
approximately 0.7% per annum) and contralateral pro-
phylactic mastectomy (CPM) offers no survival advantage.
CPM with autologous reconstruction (AR) has major
morbidity and resource implications.
Objective.
The aim of this study was to review the impact
of PREDICT survival estimates and lifetime CLBCR
scores on decision making for CPM in patients with uni-
lateral BC.
Methods.
Of
n
= 272 consecutive patients undergoing
mastectomy and AR, 252 were included. Five- and 10-year
survival was computed with the PREDICT(V2) online
prognostication tool, using age and clinicopathological
factors. Based on family history (FH) and tumor biology,
CLBCR was calculated using validated BODICEA web-
based software. Survival scores were correlated against
CLBCR estimates to identify patients receiving CPM with
‘low’ CLBCR (
\
30% lifetime risk) and poor prognosis (5-
year survival
\
80%). Patients with ‘high’ CLBCR
receiving unilateral mastectomy (UM) were similarly
identified (UK National Institute of Health and Care
Excellence [NICE] criteria for CPM,
C
30% lifetime BC
risk). Justifications motivating CPM were investigated.
Results.
Of 252 patients, 215 had UM and 37 had bilateral
mastectomy and AR. Only 23 (62%) patients receiving
CPM fulfilled the NICE criteria. Of 215 patients, 5 (2.3%)
failed to undergo CPM despite high CLBCR and good
prognosis. CPMs were performed, at the patient’s request,
for no clear justification (
n
= 8), contralateral non-invasive
disease, and/or FH (
n
= 5), FH alone (
n
= 4) and ipsilateral
cancer recurrence-related anxiety (
n
= 3).
Conclusion.
In the absence of prospective risk estimates
of CLBCR and prognosis, certain patients receive CPM
and reconstruction despite modest CLBCR, yet a propor-
tion of patients with good prognoses and substantial risk
are not undergoing CPM