Cited by 153BRCA gene mutations in cancerBreast Implant and ReconstructionWomen's cancer prevention and management

Prophylactic Mastectomy in BRCA1/2 Mutation Carriers and Women at Risk of Hereditary Breast Cancer: Long-Term Experiences at the Rotterdam Family Cancer Clinic

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Heemskerk-Gerritsen, Bernadette A. M., Brekelmans, Cecile T. M., Menke-Pluymers, Marian B. E., van Geel, Albert N., Tilanus-Linthorst, Madeleine M. A., Bartels, Carina C. M., Tan, Murly, Meijers-Heijboer, Hanne E. J. +2 more·2007·Annals of Surgical Oncology

Abstract

BACKGROUND: BRCA1/2 mutation carriers and women from a hereditary breast(/ovarian) cancer family have a highly increased risk of developing breast cancer (BC). Prophylactic mastectomy (PM) results in the greatest BC risk reduction. Long-term data on the efficacy and sequels of PM are scarce. METHODS: From 358 high-risk women (including 236 BRCA1/2 carriers) undergoing PM between 1994 and 2004, relevant data on the occurrence of BC in relation to PM, complications in relation to breast reconstruction (BR), mutation status, age at PM and preoperative imaging examination results were extracted from the medical records, and analyzed separately for women without (unaffected, n = 177) and with a BC history (affected, n = 181). RESULTS: No primary BCs occurred after PM (median follow-up 4.5 years). In one previously unaffected woman, metastatic BC was detected almost 4 years after PM (primary BC not found). Median age at PM was younger in unaffected women (P < .001), affected women more frequently were 50% risk carriers (P < .001). Unexpected (pre)malignant changes at PM were found in 3% of the patients (in 5 affected, and 5 unaffected women, respectively). In 49.6% of the women opting for BR one or more complications were registered, totaling 215 complications, leading to 153 surgical interventions (71%). Complications were mainly related to cosmetic outcome (36%) and capsular formation (24%). CONCLUSIONS: The risk of developing a primary BC after PM remains low after longer follow-up. Preoperative imaging and careful histological examination is warranted because of potential unexpected (pre)malignant findings. The high complication rate after breast reconstruction mainly concerns cosmetic issues.

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  • Selection bias for referral to the psychologist occurred, supported by the observation that unaffected women significantly exceeded affected women whereas the institution's prophylactic mastectomy population is about 50% affected.

    “The observation that the number of unaffected women significantly exceeded that of the affected women, whereas the number of women having undergone PM at our institution consists of about 50% affected women [26], supports the idea that selection bias for referral to the psychologist has indeed occurred.”

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Authors
Heemskerk-Gerritsen, B. A. M., Brekelmans, C. T. M., Menke-Pluymers, M. B. E., van Geel, A. N., Tilanus-Linthorst, M. M. A., Bartels, C. C. M., Tan, M., Meijers-Heijboer, H. E. J., Klijn, J. G. M., & Seynaeve, C.
Affiliations
Erasmus MC Cancer Institute (NL)
Corresponding author
Seynaeve, Caroline
Venue
Annals of Surgical Oncology
Published
2007-05-31
Volume
14
Issue
12
Pages
3335-3344
ISSN
  • 1068-9265 (ISSN-L)
  • 1534-4681
OpenAlex
W2108830626
Cited by
153
References
38
Citations by year
2026: 3 · 2025: 3 · 2024: 4 · 2023: 10 · 2022: 7 · 2021: 6 · 2020: 5 · 2019: 5 · 2018: 7 · 2017: 7 · 2016: 11 · 2015: 9 · 2014: 14 · 2013: 14 · 2012: 6
FWCI
5.89
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • Annals of Surgical Oncology (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion, other-oa)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
  • RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › BRCA gene mutations in cancer
  • Health Sciences › Medicine › Surgery › Breast Implant and Reconstruction
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
Keywords
prophylactic mastectomy, BRCA1 mutation carriers, BRCA2 mutation carriers, hereditary breast cancer, breast reconstruction complications, capsular contracture, cosmetic outcome, preoperative imaging, breast cancer risk reduction, high-risk women
MeSH terms
Adult, Breast Neoplasms, Female, Follow-Up Studies, Humans, Longitudinal Studies, Mastectomy, Middle Aged, Mutation, Neoplasm Staging, Netherlands, Ovarian Neoplasms, Postoperative Complications, Prospective Studies, Retrospective Studies, Risk Factors, Cohort Studies, Incidence, Mammaplasty, Treatment Outcome, Germ-Line Mutation, BRCA1 Protein, Genetic Predisposition to Disease, BRCA2 Protein

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