Habib Rahbar MD, Presenter: Nothing to Disclose

No-Lin Yeh MS, Abstract Co-Author: Nothing to Disclose

Lucy Hanna MS, Abstract Co-Author: Nothing to Disclose

Constantine Gatsonis PhD, Abstract Co-Author: Research Consultant, WILEX AG Research Consultant, BioMimetic Therapeutics, Inc Research Consultant, Endocyte, Inc

Mary C. Mahoney MD, Abstract Co-Author: Scientific Advisory Board, Hologic, Inc Research support, Naviscan, Inc Consultant, Johnson & Johnson

Mitchell Dennis Schnall MD, PhD, Abstract Co-Author: Research Grant, Siemens AG

Wendy Burton Demartini MD, Abstract Co-Author: Nothing to Disclose

Constance D. Lehman MD,PhD, Abstract Co-Author: Research Consultant, Bayer AG Research Consultant, General Electric Company Research Consultant, Koninklijke Philips Electronics NV

The rate of contralateral prophylactic mastectomy (CPM) in patients with newly diagnosed breast cancer has increased over the past decade. This has paralleled rising breast MR use in this population, and some have suggested MR utilization alone may lead to CPM. We sought to assess which patient and MR factors are associated with patients’ decisions to undergo CPM.

After IRB approval, we included 934 women enrolled in the American College of Radiology Imaging Network (ACRIN) 6667 trial who did not have known contralateral cancer at the time of surgical planning. Assessed variables included age, ethnicity, menopause status, family history of breast cancer, MR BI-RADS assessment, histology of index breast cancer, and mammographic breast density (<50% vs. >50% glandular). MR assessments of BI-RADS 0, 3, 4, or 5 were grouped as positive and assessments of 1 or 2 were grouped as negative. Associations of variables with CPM were assessed using Fisher's Exact Test and multivariate logistic regression analyses. 

86/934 (9.2%) women underwent CPM. Women who opted for CPM were more likely to be younger (mean age 48 vs. 54, p<0.0001), be premenopausal (64% vs. 41%, p<0.0001), have ductal carcinoma in situ (DCIS) in the index breast (31.4% vs. 19.3%, p=0.019), have greater breast density (82.6% vs. 67.5%, p=0.004), and have a family history of breast cancer (49% vs. 35%, p=0.02) compared to those who did not undergo CPM. Patient ethnicity distribution was similar in both groups. In multivariate modeling, young age, greater breast density, DCIS index cancer, and family history of breast cancer remained significant while menopause status did not. Positive breast MR examinations were not associated with more frequent CPM (p=0.43).

Patient factors and not breast MR recommendations are chief determinants in the decision to undergo CPM. Patient attitudes regarding index breast DCIS diagnoses should be studied further to better understand the correlation with CPM rates. *ACRIN receives funding from the National Cancer Institute through the grants U01 CA079778 and U01 CA080098. This study also was supported by an ACRIN Young Investigator Initiative Grant.

Studies assessing correlation between MR use and CPM should include patient factors known to impact CPM rates. Further study to elucidate the effect of DCIS diagnoses on CPM rates is warranted.  

Rahbar, H, Yeh, N, Hanna, L, Gatsonis, C, Mahoney, M, Schnall, M, Demartini, W, Lehman, C, Contralateral Prophylactic Mastectomy in the American College of Radiology Imaging Network (ACRIN) 6667 Trial: Impact of Breast MR Assessments and Patient Characteristics.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12021984.html