Meeting News CoveragePerspective

Younger, premenopausal women with LCIS more likely to choose BPM

ASCO 2011 Breast Cancer Symposium

SAN FRANCISCO - Patients with lobular carcinoma in situ were more likely to select bilateral prophylactic mastectomy over surveillance, with or without chemoprevention, if they were younger and premenopausal, according to a study presented here at the 2011 ASCO Breast Cancer Symposium.

Patients with lobular carcinoma in situ (LCIS) have three management options, according to Shirin Muhsen, MD, research fellow at Memorial Sloan-Kettering Cancer Center. They are: high-risk surveillance alone, high-risk surveillance with chemoprevention, and bilateral prophylactic mastectomy (BPM). Muhsen and colleagues studied patient characteristics and clinical factors associated with the decision to pursue BPM.

The researchers prospectively included women who presented to Sloan-Kettering with LCIS from 1995 to 2009. Patients with previous or concurrent diagnosis of breast cancer were excluded. Comparisons were made between women who elected BPM and those who elected high-risk surveillance with or without chemoprevention.

The study included 995 patients who presented during the study period with LCIS: 80% of these patients chose surveillance alone, 15% chose surveillance with chemoprevention and 5% chose BPM.

Patients who underwent BPM were younger, with a mean age of 48 years compared with 52 years (P<.001), and more likely to be premenopausal: 82% vs. 57% (P<.001). They were also more likely to present with bilateral LCIS and more likely to have one first-degree relative with breast cancer or two second-degree relatives with breast cancer. In addition, they were also more likely to have extremely dense breasts according to Breast Imaging Reporting and Data System density staging.

"Bilateral prophylactic mastectomy is the preferred management option for a minority of LCIS patients at Sloan-Kettering," Muhsen said. "Further research to define how the increased risk imparted by LCIS is augmented by these clinical risk factors may allow for improved methods of risk stratification and more informed discussions with patients."

For more information:

  • Muhsen S. #148. Presented at: 2011 Breast Cancer Symposium; Sept. 8-10; San Francisco.

Disclosure: Dr. Muhsen reports no relevant financial disclosures.

PERSPECTIVE

Debu Tripathy, MD
Debu Tripathy, MD

This study, while it involves a very large registry, is really not that informative. It reveals that patients with LCIS mostly choose surveillance, with or without tamoxifen or raloxifene, and those who choose mastectomy have additional risk factors. This is not very surprising. It does not shed light on whether such decisions are worthwhile - there is not a measurable effect on the risk of getting breast cancer or dying of breast cancer.

– Debu Tripathy, MD
HemOnc Today Editorial Board member

Disclosure: Dr. Tripathy reports no relevant financial disclosures.

Earn CME this spring at the HemOnc Today Breast Cancer Review & Perspective meeting to be held March 23-24, 2012 at the Hilton San Diego Bayfront. See details at HemOncTodayBreastCancer.com.

Twitter Follow HemOncToday.com on Twitter.

ASCO 2011 Breast Cancer Symposium

SAN FRANCISCO - Patients with lobular carcinoma in situ were more likely to select bilateral prophylactic mastectomy over surveillance, with or without chemoprevention, if they were younger and premenopausal, according to a study presented here at the 2011 ASCO Breast Cancer Symposium.

Patients with lobular carcinoma in situ (LCIS) have three management options, according to Shirin Muhsen, MD, research fellow at Memorial Sloan-Kettering Cancer Center. They are: high-risk surveillance alone, high-risk surveillance with chemoprevention, and bilateral prophylactic mastectomy (BPM). Muhsen and colleagues studied patient characteristics and clinical factors associated with the decision to pursue BPM.

The researchers prospectively included women who presented to Sloan-Kettering with LCIS from 1995 to 2009. Patients with previous or concurrent diagnosis of breast cancer were excluded. Comparisons were made between women who elected BPM and those who elected high-risk surveillance with or without chemoprevention.

The study included 995 patients who presented during the study period with LCIS: 80% of these patients chose surveillance alone, 15% chose surveillance with chemoprevention and 5% chose BPM.

Patients who underwent BPM were younger, with a mean age of 48 years compared with 52 years (P<.001), and more likely to be premenopausal: 82% vs. 57% (P<.001). They were also more likely to present with bilateral LCIS and more likely to have one first-degree relative with breast cancer or two second-degree relatives with breast cancer. In addition, they were also more likely to have extremely dense breasts according to Breast Imaging Reporting and Data System density staging.

"Bilateral prophylactic mastectomy is the preferred management option for a minority of LCIS patients at Sloan-Kettering," Muhsen said. "Further research to define how the increased risk imparted by LCIS is augmented by these clinical risk factors may allow for improved methods of risk stratification and more informed discussions with patients."

For more information:

  • Muhsen S. #148. Presented at: 2011 Breast Cancer Symposium; Sept. 8-10; San Francisco.

Disclosure: Dr. Muhsen reports no relevant financial disclosures.

PERSPECTIVE

Debu Tripathy, MD
Debu Tripathy, MD

This study, while it involves a very large registry, is really not that informative. It reveals that patients with LCIS mostly choose surveillance, with or without tamoxifen or raloxifene, and those who choose mastectomy have additional risk factors. This is not very surprising. It does not shed light on whether such decisions are worthwhile - there is not a measurable effect on the risk of getting breast cancer or dying of breast cancer.

– Debu Tripathy, MD
HemOnc Today Editorial Board member

Disclosure: Dr. Tripathy reports no relevant financial disclosures.

Earn CME this spring at the HemOnc Today Breast Cancer Review & Perspective meeting to be held March 23-24, 2012 at the Hilton San Diego Bayfront. See details at HemOncTodayBreastCancer.com.

Twitter Follow HemOncToday.com on Twitter.

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