Prophylactic mastectomy in high risk patients: a practice-based review of the indications. Do we follow guidelines?
BACKGROUND
recently, the number of prophylactic mastectomies (PM) in the United States has increased due to a better understanding of the genetic and biological behavior of breast cancer. Consensus guidelines regarding indications for PM are published; however, studies evaluating adherence to published guidelines are lacking. The present study analyzed the indications and possible decision-making process leading to PM among 579 patients who underwent mastectomy.


METHODS
data from 579 female patients who underwent mastectomies between 01/2005 and 12/2007 were retrospectively collected and analyzed.


RESULTS
PM was performed in 128 patients. Contralateral prophylactic mastectomy was performed in 103 patients (80.5%), and 21 (16.4%) underwent bilateral prophylactic mastectomy (four patients (3.12%) with bilateral pathology were excluded). with a mean age of 49 ± 9 years. The indications for PM, either alone or in combination, included strong family history, prior history of breast cancer, histological risk factors and a BRCA mutation.


CONCLUSIONS
strong family history was the most common indication for PM and adherence to published consensus guidelines regarding the indications for PM was 97.6%. Depression, anxiety and hypothyroidism were the most common co-morbidities observed and the effect these conditions may have on the decision-making process for PM requires further evaluation.
Hoover
Derrick J
DJ
Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ 07039, USA.
Paragi
Prakash R
PR
Santoro
Elissa
E
Schafer
Sarah
S
Chamberlain
Ronald S
RS
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics / Q000473:pathology / Q000517:prevention & control*; D003657:Decision Making; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D019983:Guideline Adherence; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009154:Mutation; D010375:Pedigree; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States