Patient selection: contralateral prophylactic mastectomy
Exclusion: significant finding in contralateral breast prior to surgery
Predictors for significant pathology in prophylactic contralateral mastectomy:
(1) lobular carcinoma
(2) moderate to high risk pathology (LCIS, ALH, ADH) in ipsilateral breast
(3) age > 40 years
(4) cancer estrogen receptor positivity
(5) cancer progesterone receptor positivity
where:
• LCIS = lobular carcinoma in situ, ALH = atypical lobular hyperplasia, ADH = atypical ductal hyperpleasia
The presence of breast cancer in a first-degree relative was not identified as an independent risk factor. A Gail model 5-year risk >= 1.67% was not a risk factor. BRCA testing data was not presented.
The extent of the pathologic exam may influence detection of significant pathology, especially in focal involvement. The protocol in the study involved sampling from (1) each quadrant, (2) central upper and lower breast, (3) nipple, and (4) any macriscopic lesions. Additional sections were taken if abnormalities were seen on the histologic exam.
