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Oncology Advances January 2017

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4 | Oncology Advances While rates of contralateral prophylactic mastectomy (CPM) more than tripled between 2002 and 2012, researchers at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) have found no survival benefit among patients choosing CPM over breast conservation. DF/BWCC researchers are conduct- ing ongoing research to examine the primary factors that con- tribute to patients' decisions to undergo CPM. Large-scale Study Reveals Trends in CPM In a study published online earlier this year in the Annals of Sur- gery, DF/BWCC investigators analyzed data from nearly 500,000 women with a diagnosis of unilateral breast cancer (Stage I to Stage III) who had an average follow-up of 8.25 years, from 1998-2012. Of the 496,488 women in the study, 59.6 percent underwent breast-conserving surgery, 33.4 per- cent underwent unilateral mastectomy, and seven percent un- derwent CPM. Overall, the proportion of women choosing CPM increased from 3.9 percent in 2002 to 12.7 percent in 2012. When com- pared with breast-conserving therapy, no significant improve- ment in breast cancer-specific survival or overall survival was found for women undergoing CPM, regardless of hormone re- ceptor status or age. "This study demonstrates a sharp and sustained increase in the number of women choosing CPM," said Mehra Golshan, MD, the lead author of the study, Distinguished Chair in Surgical On- cology at Brigham and Women's Hospital, and Medical Director of International Oncology Programs at DF/BWCC. "As we counsel women on the risks and benefits of this option, it is im- portant that we understand why more women who are at low risk for developing breast cancer in the unaffected breast are selecting CPM." Current Research in Young Women with Breast Cancer A current longitudinal study led by Principal Investigator Ann Partridge, MD, MPH, Director of the Program for Young Women with Breast Cancer and Director of the Adult Survivor- ship Program at DF/BWCC, is helping to investigate treatment decision making, including CPM, and other aspects of care in younger women. In the Young Women's Breast Cancer Study, investigators are following 1,300 women ages 40 and younger with newly-diag- nosed breast cancer from academic and community health care institutions. Participants complete surveys and provide blood samples and tumor tissue after surgery. The women are sur- veyed every six months for the first three years after diagnosis, then yearly thereafter for an additional seven years (for a total follow-up of at least 10 years following diagnosis). Team Investigates Key Factors in Patient Decision Making Amid Growing Rates and Lack of Survival Benefit in Contralateral Prophylactic Mastectomy Researchers are evaluating: • Short and long-term disease and treatment issues; • Tumor biology and the relationship to patient outcomes; • Psychosocial concerns at baseline and in follow-up. In an analysis of data from the Young Women's Breast Cancer Study, Dr. Partridge and researcher Shoshana Rosenberg, ScD, MPH, recently found a substantial increase in the number of women undergoing BRCA testing, with 77 percent of women diagnosed in 2006 opting for BRCA testing compared with 95 percent for those diagnosed in 2013 (JAMA Oncol. 2016 Jun 1;2(6):730-6.). Among all women included in the study, nearly 30 percent indicated that knowledge or concern about genetic risk influenced treatment decisions. Among these patients, 86 percent of BRCA mutation carriers and 51 percent of noncar- riers chose CPM. Ann Partridge, MD, MPH Director, Program for Young Women with Breast Cancer, Director, Adult Survivorship Program, Dana-Farber/Brigham and Women's Cancer Center Researchers at Dana-Farber/Brigham and Women's Cancer Center, led by surgical oncologist Mehra Golshan, MD, have found no survival benefit among patients choosing CPM over breast conservation. Mehra Golshan, MD Dr. Abdul Mohsen and Sultana Al-Tuwaijri Distinguished Chair in Surgical Oncology, Brigham and Women's Hospital; Medical Director, International Oncology Programs, Dana-Farber/Brigham and Women's Cancer Center continued on back cover dfbwcc.org

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