title: The Manchester guidelines for contralateral risk-reducing mastectomy.
abstract: BACKGROUND
  Rates of contralateral risk-reducing mastectomy (CRRM) are rising, despite a decreasing global incidence of contralateral breast cancer. Reasons for requesting this procedure are complex, and we have previously shown a variable practice amongst breast and plastic surgeons in England. We propose a protocol, based on a published systematic review, a national UK survey and the Manchester experience of CRRM.
  
  
  METHODS
  We reviewed the literature for risk factors for contralateral breast cancer and have devised a 5-step process that includes history taking, calculating contralateral breast cancer risk, cooling off period/counselling, multi-disciplinary assessment and consent. Members of the multi-disciplinary team included the breast surgeon, plastic surgeon and geneticist, who formulated guidelines.
  
  
  RESULTS
  A simple formula to calculate the life-time risk of contralateral breast cancer has been devised. This allows stratification of breast cancer patients into different risk-groups: low, above average, moderate and high risk. Recommendations vary according to different risk groups.
  
  
  CONCLUSIONS
  These guidelines are a useful tool for clinicians counselling women requesting CRRM. Risk assessment is mandatory in this group of patients, and our formula allows evidence-based recommendations to be made.
authors.affiliation: Nightingale and Genesis Prevention Centre, University Hospital South Manchester, Southmoor Road, Manchester, M23 9LT, UK. naren_basu@hotmail.com.|Queen Elizabeth Hospital, Birmingham, B15 2TH, UK. naren_basu@hotmail.com.
authors.forename: Narendra Nath
authors.initials: NN
authors.lastname: Basu
authors.affiliation: The Institute of Cancer Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
authors.forename: G L
authors.initials: GL
authors.lastname: Ross
authors.affiliation: Nightingale and Genesis Prevention Centre, University Hospital South Manchester, Southmoor Road, Manchester, M23 9LT, UK.|St. Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK.
authors.forename: D G
authors.initials: DG
authors.lastname: Evans
authors.affiliation: Nightingale and Genesis Prevention Centre, University Hospital South Manchester, Southmoor Road, Manchester, M23 9LT, UK.
authors.forename: L
authors.initials: L
authors.lastname: Barr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D015233:Models, Statistical; D017410:Practice Guidelines as Topic; D011379:Prognosis; D018570:Risk Assessment; D040242:Risk Reduction Behavior