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Researchers identify Risk Factors for
Contralateral Breast Cancer
Newswise — A preventive procedure to remove the unaffected
breast in breast cancer patients with
disease in one breast may only be necessary
in patients who have high-risk features as
assessed by examining the patient's medical
history and pathology of the breast cancer,
according to researchers at The University
of Texas M. D. Anderson Cancer Center.
Their findings, published in the March 1, 2009 issue of
Cancer, may help physicians predict the
likelihood of patients developing breast
cancer in the opposite breast (contralateral
breast cancer), stratify risk and counsel
patients on their treatment options.
"Women often consider contralateral prophylactic mastectomy
(CPM) not because of medical recommendation,
but because they fear having their breast
cancer return," said Kelly Hunt, M.D.,
professor in the Department of Surgical
Oncology at M. D. Anderson and lead author
on the study.
"Currently it is very difficult to identify which patients
are at enough risk to benefit from this
aggressive and irreversible procedure.
"Our goal was to determine what characteristics defined
these high-risk patients to better inform
future decisions regarding CPM."
According to the researchers, approximately 2.7 percent of
women diagnosed with breast cancer choose to
have CPM.
Recent statistics have shown that the rate of CPM in women
with stage I-III breast cancer increased by
150 percent from 1998 to 2003 in the United
States.
Potential reasons breast cancer patients choose to undergo
CPM include risk reduction, difficult
surveillance and reconstructive issues such
as symmetry and/or balance.
To begin to classify such risk factors, researchers
reviewed the cases of 542 women with breast
cancer only in one breast who received CPM
to remove the second breast at M. D.
Anderson from January 2000 to April 2007.
Out of this group, 435 patients had no abnormal pathology
identified in the opposite breast, 25
patients had contralateral breast cancer
identified at surgery, and 82 patients had
abnormal cells (atypical ductal hyperplasia,
atypical lobular hyperplasia and lobular
carcinoma in situ) that indicate a moderate
to high-risk for breast cancer development
in the contralateral breast found at the
time of surgery.
Further analysis of the patients with contralateral breast
cancer revealed that a five-year Gail risk
of 1.67 percent or greater; an invasive
lobular histology; and multiple tumors in
the original breast were all strong
predictors for contralateral breast cancer.
Patient race, estrogen receptor status and progesterone
receptor status were not associated with
increased risk.
"We went from having very little information on the benefit
of this procedure for individual patients to
identifying three independent and
significant risk factors," Hunt said.
"Each provides valuable insight into how likely a woman is
to develop the disease in her other breast
and enables physicians to make an educated
recommendation if a patient will potentially
benefit from CPM."
The Gail model, typically used for patients without breast
cancer, evaluates factors such age, age at
menarche, number and findings of previous
breast biopsies, age at first live birth and
number of first-degree relatives with breast
cancer, has been validated in several
studies to calculate the risk of developing
an invasive breast cancer over the next five
years.
The five-year risk of 1.67 percent is traditionally
used as the cutoff point for the definition
of "high risk."
"We've always known contralateral breast cancer risk is not
the same for all women and it is unnecessary
to perform preventive mastectomies
routinely.
"As we begin to clarify the specific risk factors, the
number of women undergoing CPM may decrease
and those with a low to moderate-risk may be
more open to less extreme options for risk
reduction, such as hormonal therapy and
newer agents for prevention of breast
cancer."
In addition to Hunt, other M. D. Anderson researchers
contributing to this study include Min Yi,
M.D., Funda Meric-Bernstam, M.D., Isabelle
Bedrosian, M.D., Gildy V. Babiera, M.D.,
Rosa F. Hwang, M.D., Henry Kruerer, M.D.,
all in the Department of Surgical Oncology;
Lavinia P. Middleton, M.D., in the
Department of Pathology; Banu K. Arun, M.D.,
in the Department of Breast Medical
Oncology; and Wei Yang, M.D., in the
Department of Diagnostic Imaging.
About M. D. Anderson
The University of Texas M. D. Anderson
Cancer Center in Houston ranks as one of the
world's most respected centers focused on
cancer patient care, research, education and
prevention. M. D. Anderson is one of only 41
Comprehensive Cancer Centers designated by
the National Cancer Institute. For four of
the past six years, M. D. Anderson has
ranked No. 1 in cancer care in "America's
Best Hospitals," a survey published annually
in U.S. News and World Report.
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