Prophylactic mastectomy in high risk patients: a practice-based review of the indications. Do we follow guidelines?

BACKGROUND

recently, the number of prophylactic mastectomies (PM) in the United States has increased due to a better understanding of the genetic and biological behavior of breast cancer. Consensus guidelines regarding indications for PM are published; however, studies evaluating adherence to published guidelines are lacking. The present study analyzed the indications and possible decision-making process leading to PM among 579 patients who underwent mastectomy.

STUDY DESIGN

data from 579 female patients who underwent mastectomies between 01/2005 and 12/2007 were retrospectively collected and analyzed.

RESULTS

PM was performed in 128 patients. Contralateral prophylactic mastectomy was performed in 103 patients (80.5%), and 21 (16.4%) underwent bilateral prophylactic mastectomy (four patients (3.12%) with bilateral pathology were excluded). with a mean age of 49 ± 9 years. The indications for PM, either alone or in combination, included strong family history, prior history of breast cancer, histological risk factors and a BRCA mutation.

CONCLUSIONS

strong family history was the most common indication for PM and adherence to published consensus guidelines regarding the indications for PM was 97.6%. Depression, anxiety and hypothyroidism were the most common co-morbidities observed and the effect these conditions may have on the decision-making process for PM requires further evaluation.