Prophylactic mastectomy - Pathologic findings in high-risk patients

Background.-According to recently published data, prophylactic mastectomy ( PM) appeals to prevent about 90% of the expected malignant neoplasms in wom en wi th a family history of breast cancer. Objectives.-To identify the frequency of high-risk lesions in PM specimens and to determine occurrence of any new primary breast cancer following PM. Design.-We performed a retrospective study of women undergoing unilateral o r bilateral PM. Medical charts and pathologic findings of 35 patients who u nderwent bilateral mastectomies at University Hospital, Syracuse, NY, from 1989 to 1996 were reviewed. Patients with biopsy-proven bilateral breast ca ncer were excluded. Patients were divided into 3 groups: (A) positive famil y history and no known breast cancer (n = 9), (B) positive family history a nd contralateral neoplasia (n = 13), and (C) negative family history and co ntralateral neoplasia (n = 13). These findings were compared with those fou nd in reduction mammoplasty specimens from 10 women at standard risk of bre ast canter. Results.-The mean age of the control group of women undergoing reduction ma mmoplasty was 38 years. The pathologic specimens demonstrated no significan t pathologic findings in 9 and fibrocystic change in 1. In group A, the mea n number of affected relatives was 3.1, and the mean age was 38 years, Two of these 9 women had atypical duct hyperplasia and 1 had atypical lobular h yperplasia in their breasts (ie, 33% with high-risk pathologic findings). O f the 13 group B women (mean age, 46.6 years; mean of 2.5 affected relative s and unilateral breast cancer), the contralateral PM specimen contained du ct carcinoma in situ in one and invasive ductal cancer in a second (15% wit h occult malignant neoplasms). In 13 group C patients (mean age, 47.1 years ), 3 (23.1%) of the contralateral PM specimens displayed atypical duct hype rplasia or atypical lobular hyperplasia. At a mean follow-up of 4.8 years, there have been no new breast malignant neoplasms in these 45 women. Conclusions.-The occurrence of unilateral cancer in patients with family hi story of breast cancer is associated with a 15.4% probability of simultaneo us occult malignant neoplasms in the contralateral breast. Patients with a strong family history but no evidence of breast cancer have a substantially similar rate of proliferative disease in their PM specimens as those women who have unilateral cancer but no significant family history.