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Vol. 98. Issue 10.
Pages 612-617 (December 2020)
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Vol. 98. Issue 10.
Pages 612-617 (December 2020)
Original article
DOI: 10.1016/j.cireng.2020.11.009
Contralateral breast cancer and tumor recurrence in BRCA1/2 carriers and non-carriers at a high risk of hereditary breast cancer after bilateral mastectomy
Cáncer de mama contralateral y recurrencia en portadoras BRCA1/2 y no portadoras con alto riesgo de cáncer de mama hereditario tras mastectomía bilateral
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Marta Allué Cabañuza,
Corresponding author
martitaallue@hotmail.com

Corresponding author.
, María Domingo Bretónb, Jorge Chóliz Ezquerroc, María Dolores Arribas del Amoa, Antonio Tomás Güemes Sánchezd
a Unidad de Mama, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
b Servicio de Cirugía General, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
c Servicio de Cirugía General, Hospital Universitario Miguel Servet, Zaragoza, Spain
d Universidad de Zaragoza, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
Article information
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Figures (2)
Tables (4)
Table 1. Demographic data related to surgical technique.
Table 2. Clinical-pathological tumor data.
Table 3. Oncologic results.
Table 4. Univariate regression models showing only results that are statistically significant.
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Abstract
Introduction

Contralateral prophylactic mastectomy (CPM) has been reported to reduce risk of contralateral breast cancer (CBC) by at least 90%. In addition, BRCA carriers present higher risk of ipsilateral recurrence and a second primary tumor.

The aim is to evaluate risk of CBC and recurrence and to analyze predictive factors in BRCA1/2 mutation carriers and non-carriers at high-risk of hereditary breast cancer patients.

Methods

Retrospective observational study. 46 patients underwent bilateral mastectomy during 2004–2018.

Results

Cohort comprised of 9 patients BRCA1, 12 BRCA2 and 25 at high-risk without mutation. Median follow-up was 79 months. 16 patients recently diagnosed and 30 previously treated for breast cancer who underwent CPM a second time (because of later detection of BRCA mutation in 10 cases). The external lateral incision was the most frequent surgical technique. In all patients, immediate reconstruction was performed.

In CPM pieces, 4 in situ carcinoma, 3 invasive and 1 atypical hyperplasia were found. The incidence of occult contralateral cancer was 15.2%. Recurrence was observed in 5 patients a mean of 21.2 months after surgery. DFSD was 83.74 months and OS 84.33 months. Regression models identified BRCA1/2 mutation and high risk without mutation as significant occult tumor predictive factors while tumor size2cm was predictive of recurrence.

Conclusions

In our series we found a 10.8% recurrence despite CPM and 7 patients (15.2%) would have developed a CBC in subsequent years.

Keywords:
BRCA1
BRCA2
Hereditary breast cancer
Contralateral breast cancer
Recurrence
Resumen
Introducción

La mastectomía contralateral profiláctica (CPM) reduce el riesgo de cáncer contralateral en al menos un 90%. Además, las portadoras de mutación BRCA tienen mayor riesgo de recurrencia ipsilateral y de un segundo tumor primario. El objetivo es evaluar el riesgo de cáncer contralateral y la recurrencia, y analizar factores predictivos en pacientes con cáncer de mama y mutaciones BRCA1/2 y no portadoras con alto riesgo de cáncer hereditario.

Métodos

Análisis observacional retrospectivo de 46 pacientes sometidas a mastectomía bilateral durante 2004–2018. Nueve pacientes BRCA1, 12 BRCA2 y 25 con alto riesgo sin mutación.

Resultados

Dieciséis pacientes con diagnóstico de novo y 30 tratadas previamente por cáncer de mama a las que realizamos CPM de manera diferida (en 10 de ellas por detección de mutación en BRCA a posteriori); mediana de seguimiento 79 meses. La técnica quirúrgica más usada fue la incisión lateral externa. En todas las pacientes se realizó reconstrucción inmediata.

En las piezas de CPM se encontraron 4 tumores in situ, 3 invasivos y una hiperplasia atípica. La incidencia de cáncer contralateral oculto fue del 15,2%. Cinco pacientes presentaron recidiva 21,2 meses de media tras la intervención; SLE 83,74meses y SG 84,33meses. Los modelos de regresión identificaron mutación BRCA1/2 y alto riesgo sin mutación como factores predictivos significativos para tumor oculto, mientras que el tamaño tumoral2cm fue predictivo de recidiva.

Conclusiones

En nuestra serie 7pacientes (15,2%) habrían desarrollado un tumor contralateral en los años posteriores, y un 10,8% presentaron recurrencia a pesar de CPM.

Palabras clave:
BRCA1
BRCA2
Cáncer de mama hereditario
Cáncer de mama contralateral
Recurrencia

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