title: Predictors that influence contralateral prophylactic mastectomy election among women with ductal carcinoma in situ who were evaluated for BRCA genetic testing.
abstract: BACKGROUND
  Patients with ductal carcinoma in situ (DCIS) are at increased risk for developing contralateral breast cancer (CBC). Consequently, more women with DCIS are electing to undergo contralateral prophylactic mastectomy (CPM). We evaluated factors associated with CPM in patients with DCIS who underwent genetic counseling for BRCA testing.
  
  
  METHODS
  This retrospective study involved 165 women with DCIS referred for genetic counseling between 2003 and 2011. Patient characteristics were age, marital and educational status, tumor markers, nuclear grade, family history of breast cancer (BC) and ovarian cancer (OC), race, Ashkenazi Jewish ancestry, and BRCA results. Univariate and multivariate logistic regression analyses were used to determine predictive factors associated with CPM election.
  
  
  RESULTS
  Of 165 patients, 44 (27 %) underwent CPM. Patients <45 years of age were more likely to elect CPM (p = 0.0098). A BRCA+ mutation was found in 17 patients (10.3 %), and BRCA+ women were more likely to elect CPM than BRCA or untested women (p = 0.0001). Patients who had a family history of OC (57.7 %) were more likely to choose CPM than those with no family history (p = 0.0004). Younger age, BRCA+, and an OC family history remained significant in the multivariate model (p < 0.008).
  
  
  CONCLUSIONS
  The CPM rate among patients with DCIS who undergo genetic counseling is high. Factors associated with increased likelihood of CPM among this group were age, BRCA+, and a family history of OC. Further studies are needed to evaluate patients' perceptions of CBC risk and their role in the likelihood of CPM choice.
authors.affiliation: Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Nisreen
authors.initials: N
authors.lastname: Elsayegh
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
authors.forename: Heather
authors.initials: H
authors.lastname: Lin
authors.forename: Angelica M
authors.initials: AM
authors.lastname: Gutierrez Barrera
authors.forename: Michelle
authors.initials: M
authors.lastname: Jackson
authors.forename: Kimberly I
authors.initials: KI
authors.lastname: Muse
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Litton
authors.forename: Constance
authors.initials: C
authors.lastname: Albarracin
authors.forename: Aimaz
authors.initials: A
authors.lastname: Afrough
authors.forename: Gabriel N
authors.initials: GN
authors.lastname: Hortobagyi
authors.forename: Banu K
authors.initials: BK
authors.lastname: Arun
mesh_terms: D000367:Age Factors; D019313:BRCA1 Protein / Q000235:genetics; D024682:BRCA2 Protein / Q000235:genetics; D001943:Breast Neoplasms / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005820:Genetic Testing; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human