Modelo CBCRisk para determinar el riesgo de cáncer de mama contralateral en el cáncer de mama esporádico / CBCRisk model to determine the risk of contralateral breast cancer in sporadic breast cancer

Introducción: La mayoría de los cánceres de mama (CM) se diagnostican en mujeres sin antecedentes familiares y no portadoras de mutaciones de riesgo. En las últimas décadas se ha producido un aumento de mastectomías profilácticas contralaterales (MPC) en estas pacientes. El CBCRisk es un modelo que calcula el riesgo absoluto de cáncer de mama contralateral (CMC) y pretende servir para el asesoramiento de pacientes con CM esporádico sobre la MPC. Método: Análisis observacional retrospectivo de pacientes con un cáncer de mama esporádico sometidas a MPC durante 2017-2019. Análisis descriptivo, comparativo y de regresión logística univariante para identificar factores predictivos de LMAR y/o CMC oculto. Evaluación del modelo CBCRisk publicado en 2017 y distintos valores límite para la recomendación de MPC. Resultados: Se seleccionaron 42 pacientes. Incidencia de LMAR y cáncer oculto (CO) menor que la descrita en la literatura (9,52% LMAR, 2,38% CO). Ninguna de las variables evaluadas alcanzó significación estadística para la predicción de lesiones. El valor de CBCRisk a cinco años medio en pacientes con hallazgos patológicos fue de 2,08 (DE 0,97), superior al CBCRisk medio del conjunto (1,87 ± 0,91) y del subgrupo de MPC sin hallazgos patológicos (1,84 ± 0,91). Solo el CBCRisk ≥ 3 resultó significativo (p = 0,04) para la predicción de hallazgos patológicos. Conclusión: Las pacientes con CM esporádico deben ser adecuadamente informadas de los riesgos y beneficios estimados de la MPC. El CBCRisk puede ser útil para el asesoramiento de estas pacientes, pero precisa validación en cohortes más amplias y prospectivas. (AU)

Introduction: The great majority of breast cancer (BC) cases are diagnosed in women who have no known family history of the disease and are not carriers of any risk mutation. During the past few decades an increase in the number of contralateral prophylactic mastectomy (CPM) has been produced in these patients. The CBCRisk model calculates the absolute risk of suffering from contralateral breast cancer (CBC); thus, it can be used to counselling patients with sporadic breast cancer. Method: An observational, retrospective study including sporadic breast cancer patients treated with contralateral prophylactic mastectomy has been conducted between 2017 and 2019. A descriptive and comparative study with one variation of logistic regression has been carried out in order to identify predictive factors of occult tumors (OT) and medium/high risk damage (MHRD). Evaluation of the CBCRisk model published in 2017 and different limit values for the CPM recommendation. Results: 42 patients were selected. Incidence of MHRD and OT was lower than that described in the literatura (9.52% MHRD, 2.38% OT). None of the evaluated variables reached statistical significance for predicting injuries. The average value of CBCRisk 5 years ahead found in patients with pathological findings was 2.08 (SD 0.97), higher than the average value of the whole group (1.87 ± 0.91) and the subgroup without pathological findings (1.84 ± 0.91). Only values ≥ 3 for CBCRisk were considered statistically significant (p = 0.04) for the prediction of histological lesions. Conclusion: Patients with sporadic breast cancer should be adequately informed about the estimated risks and benefits of undergoing a contralateral prophylactic mastectomy. The CBCRisk may be useful for the counseling of these patients, but it requires validation in larger and prospective cohorts. (AU)

CBCRisk model to determine the risk of contralateral breast cancer in sporadic breast cancer.

INTRODUCTION: The great majority of breast cancer (BC) cases are diagnosed in women who have no known family history of the disease and are not carriers of any risk mutation. During the past few decades an increase in the number of contralateral prophylactic mastectomy (CPM) has been produced in these patients. The CBCRisk model calculates the absolute risk of suffering from contralateral breast cancer (CBC); thus, it can be used to counselling patients with sporadic breast cancer. METHOD: An observational, retrospective study including sporadic breast cancer patients treated with contralateral prophylactic mastectomy has been conducted between 2017 and 2019. A descriptive and comparative study with one variation of logistic regression has been carried out in order to identify predictive factors of occult tumors (OT) and medium/high risk damage (MHRD). Evaluation of the CBCRisk model published in 2017 and different limit values for the CPM recommendation. RESULTS: 42 patients were selected. Incidence of MHRD and OT was lower than that described in the literatura (9.52%MHRD, 2.38%OT). None of the evaluated variables reached statistical significance for predicting injuries. The average value of CBCRisk 5 years ahead found in patients with pathological findings was 2.08 (DE 0.97), higher than the average value of the whole group (1.87 ± 0.91) and the subgroup without pathological findings (1.84 ± 0.91). Only values >3 for CBCRisk were considered statistically significant (P = .04) for the prediction of histological lesions. CONCLUSION: Patients with sporadic breast cancer should be adequately informed about the estimated risks and benefits of undergoing a contralateral prophylactic mastectomy. The CBCRisk may be useful for the counseling of these patients, but it requires validation in larger and prospective cohorts.

CBCRisk model to determine the risk of contralateral breast cancer in sporadic breast cancer. / Modelo CBCRisk para determinar el riesgo de cáncer de mama contralateral en el cáncer de mama esporádico.

INTRODUCTION: The great majority of breast cancer (BC) cases are diagnosed in women who have no known family history of the disease and are not carriers of any risk mutation. During the past few decades an increase in the number of contralateral prophylactic mastectomy (CPM) has been produced in these patients. The CBCRisk model calculates the absolute risk of suffering from contralateral breast cancer (CBC); thus, it can be used to counselling patients with sporadic breast cancer. METHOD: An observational, retrospective study including sporadic breast cancer patients treated with contralateral prophylactic mastectomy has been conducted between 2017 and 2019. A descriptive and comparative study with one variation of logistic regression has been carried out in order to identify predictive factors of occult tumors (OT) and medium/high risk damage (MHRD). Evaluation of the CBCRisk model published in 2017 and different limit values for the CPM recommendation. RESULTS: 42 patients were selected. Incidence of MHRD and OT was lower than that described in the literatura (9.52% MHRD, 2.38% OT). None of the evaluated variables reached statistical significance for predicting injuries. The average value of CBCRisk 5 years ahead found in patients with pathological findings was 2.08 (SD 0.97), higher than the average value of the whole group (1.87 ± 0.91) and the subgroup without pathological findings (1.84 ± 0.91). Only values ≥ 3 for CBCRisk were considered statistically significant (p = 0.04) for the prediction of histological lesions. CONCLUSION: Patients with sporadic breast cancer should be adequately informed about the estimated risks and benefits of undergoing a contralateral prophylactic mastectomy. The CBCRisk may be useful for the counseling of these patients, but it requires validation in larger and prospective cohorts.

Contralateral breast cancer and tumor recurrence in BRCA1/2 carriers and non-carriers at a high risk of hereditary breast cancer after bilateral mastectomy. / Cáncer de mama contralateral y recurrencia en portadoras BRCA1/2 y no portadoras con alto riesgo de cáncer de mama hereditario tras mastectomía bilateral.

INTRODUCTION: Contralateral prophylactic mastectomy (CPM) has been reported to reduce risk of contralateral breast cancer (CBC) by at least 90%.In addition, BRCA carriers presents higher risk of ipsilateral recurrence and a second primary tumor. The aim is to evaluate risk of CBC and recurrence and to analyze predictive factors in BRCA1/2 mutation carriers and non-carriers at high-risk of hereditary breast cancer patients. METHODS: Retrospective observational study. 46 patients underwent bilateral mastectomy during 2004-2018. RESULTS: Cohort comprised 9 patients BRCA1,12 BRCA2 and 25 at high-risk without mutation. Median follow-up 79 months. 16 patients recently diagnosed and 30 previously treated by breast cancer whom underwent CPM at second time (because of later detection of BRCA mutation in 10 cases). The external lateral incision was most frequent surgical technique. In all patients immediate reconstruction was performed. In CPM pieces, 4 in situ carcinoma, 3 invasive and 1 atypical hyperplasia were found. The incidence of occult contralateral cancer was 15.2%. Recurrence was observed in 5 patients a media of 21.2 months after surgery. FSD was 83.74 months and OS 84.33 months. Regression models identified BRCA1/2 mutation and high risk without mutation as significant occult tumor predictive factors while tumor size≥2cm was predictive of recurrence. CONCLUSIONS: In our series we found a10.8% recurrence despite CPM and 7 patients (15.2%) would have developed a CBC in subsequent years.