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Ann Surg. 2018 Feb;267(2):271-279. doi: 10.1097/SLA.0000000000002309.

Indications for Contralateral Prophylactic Mastectomy: A Consensus Statement Using Modified Delphi Methodology.

Author information

1
University of Toronto, Toronto, Ontario, Canada.
2
University of Calgary, Calgary, Alberta, Canada.
3
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Abstract

OBJECTIVE:

To reach a consensus about contralateral prophylactic mastectomy in unilateral breast cancer.

SUMMARY BACKGROUND DATA:

There has been a substantial increase in the number of North American women with unilateral breast cancer undergoing a therapeutic mastectomy and a contralateral prophylactic mastectomy (CPM) either simultaneously or sequentially. The purpose of this project was to create a nationally endorsed consensus statement for CPM in women with unilateral breast cancer using modified Delphi consensus methodology.

METHODS:

A nationally representative expert panel of 19 general surgeons, 2 plastic surgeons, 2 medical oncologists, 2 radiation oncologists, and 1 psychologist was invited to participate in the generation of a consensus statement. Thirty-nine statements were created in 5 topic domains: predisposing risk factors for breast cancer, tumor factors, reconstruction/symmetry issues, patient factors, and miscellaneous factors. Panelists were asked to rate statements on a 7-point Likert scale. Two electronic rounds of iterative rating and feedback were anonymously completed, followed by an in-person meeting. Consensus was reached when there was at least 80% agreement.

RESULTS:

Our panelists did not recommend for average risk women with unilateral breast cancer. The panel recommended CPM for women with a unilateral breast cancer and previous Mantle field radiation or a BrCa1/2 gene mutation. The panel agreed that CPM could be considered by the surgeon on an individual basis for: women with unilateral breast cancer and a genetic mutation in the CHEK2/PTEN/p53/PALB2/CDH1 gene, and in women who may have significant difficulty achieving symmetry after unilateral mastectomy.

CONCLUSION:

Contralateral prophylactic mastectomy is rarely recommended for women with unilateral breast cancer.

PMID:
28594745
DOI:
10.1097/SLA.0000000000002309
[Indexed for MEDLINE]

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