55 Do Genetic Counseling and Testing Affect Rates of Contralateral Prophylactic Mastectomy in Patients Without Clinically Actionable Mutations?

Publication
Article
Miami Breast Cancer Conference® Abstracts Supplement42nd Annual Miami Breast Cancer Conference® - Abstracts
Volume 39
Issue 4
Pages: 49-50

55 Do Genetic Counseling and Testing Affect Rates of Contralateral Prophylactic Mastectomy in Patients Without Clinically Actionable Mutations?

55 Do Genetic Counseling and Testing Affect Rates of Contralateral Prophylactic Mastectomy in Patients Without Clinically Actionable Mutations?

Background

Breast cancer is most commonly a unilateral disease. Among patients with unilateral breast cancer undergoing mastectomy who are not at elevated genetic risk, rates of contralateral prophylactic mastectomy (CPM) have been increasing despite lack of evidence for improvement in outcomes. This study assesses factors influencing rates of CPM vs unilateral mastectomy (UM) in patients with unilateral primary breast cancer.

Materials and Methods

369 women with unilateral breast cancer treated with mastectomy between January 2020 and December 2023 were identified from our tumor registry for retrospective chart review. Preoperative genetic counseling (pGC) and testing were assessed and those with deleterious genetic mutations were excluded. Negative genetic results, variants of unknown significance and pending tests prior to surgery were included. Clinical and patient factors were compared using logistic regression between patients who underwent UM vs mastectomy with CPM.

Results

Of 369 patients, 223 (60.4%) underwent UM, while 146 (39.6%) chose CPM. Overall, 288 (78.0%) of patients in our study group received pGC. Of those managed with CPM, 89.7% had pGC as compared with 70.4% of patients who had UM (P <.001). Most counseled patients had genetic testing sent prior to surgery (94.4%). Patients who underwent CPM were also more likely to have had genetic testing than those managed with UM (87.0% vs 65.0%, P <.001). Younger patients were more likely to elect CPM; of 109 patients aged < 50, 67 (61.5%) had CPM while of the 260 patients aged ≥ 50, only 79 (30.4%) chose CPM (P <.001). Self-reported positive family history of breast cancer (FHx) was also associated with CPM, with 55.5% of those undergoing CPM reporting FHx compared with 42.2% for UM (P = .012). Most patients in our study had reconstruction (72.4%). Patients managed with CPM were more likely to have reconstruction (91.8% vs 59.6%, P <.001) (Table).

Table 1. Univariate Analysis of Factors Associated With CPM

Table 1. Univariate Analysis of Factors Associated With CPM

Conclusion

pGC and genetic testing were associated with a higher rate of CPM, even though patients positive for deleterious mutations were excluded from this study. Patients undergoing reconstruction, younger patients, and patients who reported FHx were also more likely to have CPM. pGC and genetic testing groups may be enriched with younger patients and/or those with FHx. Patients often have a surgical plan in place prior to receiving their genetic testing results. Our study demonstrates that the decision for CPM is correlated with factors other than documented genetic risk.

Articles in this issue

23 Clinical Outcomes in Patients With HR+/HER2− Early Breast Cancer By Prior Systemic Treatment: A Subgroup Analysis of the NATALEE Trial
23 Clinical Outcomes in Patients With HR+/HER2− Early Breast Cancer By Prior Systemic Treatment: A Subgroup Analysis of the NATALEE Trial
TPS 24 Phase Ib Dose-Finding Study of [177Lu]Lu-NeoB + Ribociclib + Fulvestrant in Patients With ER+/HER2− Advanced Breast Cancer With GRPR Expression With Early Relapse FromAdjuvant Endocrine Therapy or Progression on ET + CDK4/6i for ABC
TPS 24 Phase Ib Dose-Finding Study of [177Lu]Lu-NeoB + Ribociclib + Fulvestrant in Patients With ER+/HER2− Advanced Breast Cancer With GRPR Expression With Early Relapse FromAdjuvant Endocrine Therapy or Progression on ET + CDK4/6i for ABC
TPS 25 Phase 1/2 Study of the Novel Radioligand Therapy [177Lu]Lu-NeoB Plus Capecitabine in Patients With ER+/HER2− Advanced Breast Cancer (ABC) With GRPR Expression After Progression on Prior Endocrine Therapy Plus a CDK4/6 Inhibitor for ABC
TPS 25 Phase 1/2 Study of the Novel Radioligand Therapy [177Lu]Lu-NeoB Plus Capecitabine in Patients With ER+/HER2− Advanced Breast Cancer (ABC) With GRPR Expression After Progression on Prior Endocrine Therapy Plus a CDK4/6 Inhibitor for ABC
26 Risk of Recurrence in Real-World NATALEE- and monarchE-Eligible Populations of Patients With HR+/HER2− Early Breast Cancer in an Electronic Health Record-Derived Database
26 Risk of Recurrence in Real-World NATALEE- and monarchE-Eligible Populations of Patients With HR+/HER2− Early Breast Cancer in an Electronic Health Record-Derived Database
27 Elacestrant vs Standard of Care in ER+, HER2- Advanced or Metastatic Breast Cancer With ESR1-Mutated Tumors: ESR1 Allelic Frequencies and Clinical Activity From the Phase 3 EMERALD Trial
27 Elacestrant vs Standard of Care in ER+, HER2- Advanced or Metastatic Breast Cancer With ESR1-Mutated Tumors: ESR1 Allelic Frequencies and Clinical Activity From the Phase 3 EMERALD Trial
TPS 28 ELEGANT: Elacestrant VS Standard Endocrine Therapy in Women and Men With Node-Positive, Estrogen Receptor-Positive, HER2-Negative, Early Breast Cancer With High Risk of Recurrence in a Global, Multicenter, Randomized, Open-Label Phase 3 Study
TPS 28 ELEGANT: Elacestrant VS Standard Endocrine Therapy in Women and Men With Node-Positive, Estrogen Receptor-Positive, HER2-Negative, Early Breast Cancer With High Risk of Recurrence in a Global, Multicenter, Randomized, Open-Label Phase 3 Study
29 A Real-World Exploratory Analysis to Identify Disparities in Breast Cancer Tumor Biopsy Practice at Community Oncology Clinics in the United States
29 A Real-World Exploratory Analysis to Identify Disparities in Breast Cancer Tumor Biopsy Practice at Community Oncology Clinics in the United States
30 Imlunestrant, an Oral Selective Estrogen Receptor Degrader, as Monotherapy and Combined With Abemaciclib, for Patients with ER+, HER2– Advanced Breast Cancer, Pretreated With Endocrine Therapy: Results of the Phase 3 EMBER-3 Trial
30 Imlunestrant, an Oral Selective Estrogen Receptor Degrader, as Monotherapy and Combined With Abemaciclib, for Patients with ER+, HER2– Advanced Breast Cancer, Pretreated With Endocrine Therapy: Results of the Phase 3 EMBER-3 Trial
TPS 31 Real-World Sacituzumab Govitecan Treatment Patterns and Outcomes in Second-Line or Later Metastatic Triple-Negative Breast Cancer: Leveraging Electronic Health Records and Manual Curation of a US Database
TPS 31 Real-World Sacituzumab Govitecan Treatment Patterns and Outcomes in Second-Line or Later Metastatic Triple-Negative Breast Cancer: Leveraging Electronic Health Records and Manual Curation of a US Database
36 Expert Perspectives in the Management of Breast Cancer Brain Metastases: A Survey of 32 International Specialists
36 Expert Perspectives in the Management of Breast Cancer Brain Metastases: A Survey of 32 International Specialists
TPS 38 ELCIN: Elacestrant in Women and Men With CDK4/6 Inhibitor-Naive Estrogen Receptor-Positive, HER2-Negative Metastatic Breast Cancer: An Open-Label, Multicenter, Phase 2 Study
TPS 38 ELCIN: Elacestrant in Women and Men With CDK4/6 Inhibitor-Naive Estrogen Receptor-Positive, HER2-Negative Metastatic Breast Cancer: An Open-Label, Multicenter, Phase 2 Study
39 Development and Validation of a Questionnaire to Assess Motivation and Satisfaction in Mastectomy Patients With or Without Reconstruction
39 Development and Validation of a Questionnaire to Assess Motivation and Satisfaction in Mastectomy Patients With or Without Reconstruction
40 Frequency of Documented IHC Score in Patients With HER2-Negative Breast Cancer in the US: An Observational Study Using Guardian Research Network Data
40 Frequency of Documented IHC Score in Patients With HER2-Negative Breast Cancer in the US: An Observational Study Using Guardian Research Network Data
41 Provider Preferences and Practices in Testing and Reporting HER2 Immunohistochemistry in Patients With Breast Cancer: A Survey and Interview Study Among US Pathologists and Oncologists
41 Provider Preferences and Practices in Testing and Reporting HER2 Immunohistochemistry in Patients With Breast Cancer: A Survey and Interview Study Among US Pathologists and Oncologists
42 Exploring the Treatment Gap in High-Risk HR+, HER2– Early Breast Cancer: Eligible Patients Not Receiving Abemaciclib in the US
42 Exploring the Treatment Gap in High-Risk HR+, HER2– Early Breast Cancer: Eligible Patients Not Receiving Abemaciclib in the US
Recent Videos
Breast oncologist Jade E. Jones, MD, says she tries to send patients with BRCA-mutant HR-positive TNBC to clinical trials that use PARP inhibitors.
Following progression on a CDK4/6 inhibitor, ascertaining the endocrine sensitivity of HR-positive/HER2-negative disease may inform sequential treatment.
T-DXd improved progression-free survival over standard chemotherapy among patients with HR-positive/triple-negative breast cancer in DESTINY-Breast04.
The use of chemotherapy trended towards improved recurrence-free intervals in older patients with high-risk tumors as determined via the MammaPrint assay.
Use of a pharmacist-directed resource appears to improve provider confidence and adverse effect monitoring for patients undergoing infusion therapy.
Reshma L. Mahtani, DO, describes how updates from the DESTINY-Breast09, ASCENT-04, and VERITAC-2 trials may shift practices in the breast cancer field.
Stage IV lung cancer may be curable based on the success of the DREAM Program, according to thoracic surgeon, Ankit Bharat, MBBS,
Ankit Bharat, MBBS, a thoracic surgeon, discussed potential treatment emergent adverse effects or complications, as well as strategies for managing them.
Thoracic surgeon, Ankit Bharat, MBBS, discussed surgical strategies among patients with advanced lung cancer diagnoses based on staging.
In a CancerNetwork® YouTube video, Cornelia Tischmacher, a mother of twins from Germany, outlined her receipt of double lung transplantation.
Related Content