ORIGINAL ARTICLES

Risk reducing mastectomy: outcomes in 10 European centres

D G R Evans^1,2, A D Baildam³, E Anderson⁴, A Brain³, A Shenton¹, H F A Vasen⁵, D Eccles⁶, A Lucassen⁶, G Pichert⁷, H Hamed⁷, P Moller⁸, L Maehle⁸, P J Morrison⁹, D Stoppat-Lyonnet¹⁰, H Gregory¹¹, E Smyth¹¹, D Niederacher¹², C Nestle-Krämling¹², J Campbell⁴, P Hopwood¹³, F Lalloo¹, A Howell²

¹ Medical Genetics Research Group and Regional Genetics Service, University of Manchester and Central Manchester and Manchester Children’s University Hospitals NHS Trust, St Mary’s Hospital, Manchester, UK
² Genesis Prevention Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, UK
³ Departments of Breast and Plastic Surgery, Wythenshawe Hospital, Manchester, UK
⁴ South East Scotland Breast Screening Programme Ardmillan House, 42 Ardmillan Terrace, Edinburgh EH11 2JL
⁵ Foundation for the Detection of Hereditary Tumours, Leiden, Netherlands
⁶ CRC Genetic Epidemiology Research Group, Wessex Regional Genetics Service, Southampton, UK
⁷ Division of Medical and Molecular Genetics and Surgery, Guy’s Hospital, London, UK
⁸ Section for Inherited Cancer, Department of Medical Genetics, The National Hospital, Oslo, Norway
⁹ Department of Medical Genetics, Belfast HSC Trust, Belfast, UK
¹⁰ Unite de Genetique Oncologique, Institut Curie, Paris, France
¹¹ Department of Medical Genetics and Surgery, University of Aberdeen, Foresterhill, Aberdeen, UK
¹² Department Obstetrics and Gynecology, University Medical Clinic Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
¹³ Psycho-Oncology, The Christie NHS Trust, Withington, Manchester, UK

Dr D G R Evans, Central Manchester and Manchester Children’s University Hospitals NHS Trust, St Mary’s Hospital, Manchester, M13 0JH, UK; gareth.evans{at}cmmc.nhs.uk

Background: Increasingly women at high risk of breast cancer are opting for risk reducing surgery. The aim of this study was to assess the effectiveness of this approach in women at high risk in both carriers and non-carriers of BRCA1/2.

Methods: Data from 10 European centres that offer a genetic counselling and screening service to women at risk were obtained prospectively from 1995. Breast cancer risks were estimated from life tables and a control group of women at risk who did not undergo surgery.

Results: The combined centres have data on 550 women who have undergone risk reducing mastectomy with greater than 3334 women years of follow-up. Operations were carried out on women with lifetime risks of 25–80%, with an average expected incidence rate of 1% per year. No breast cancers have occurred in this cohort in the "at risk" unaffected breast, whereas >34 would have been expected. A high rate (2–3.6%) of occult disease was identified in the at risk breast at the time of surgery.

Interpretation: We conclude that risk reducing surgery is highly effective.

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• Evans, D. G. R., Lalloo, F., Ashcroft, L., Shenton, A., Clancy, T., Baildam, A. D., Brain, A., Hopwood, P., Howell, A. (2009). Uptake of Risk-Reducing Surgery in Unaffected Women at High Risk of Breast and Ovarian Cancer Is Risk, Age, and Time Dependent. Cancer Epidemiol. Biomarkers Prev. 18: 2318-2324 [Abstract] [Full Text]