Imperial College London
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Mr Daniel Richard Leff

Faculty of Medicine, Department of Surgery & Cancer

Reader in Breast Surgery
 
 
 
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Contact

 

d.leff Website

 
 
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Location

 

016Paterson WingSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Leff:2018:10.1245/s10434-018-6593-4,
author = {Leff, DR and de, Silva T and Henry, F and Thiruchelvam, P and Hadjiminas, D and Al-Mufti, R and Hogben, K and Hunter, J and Wood, S and Jalalli, N},
doi = {10.1245/s10434-018-6593-4},
journal = {Annals of Surgical Oncology},
pages = {3057--3063},
title = {Streamlining decision making in contralateral risk-reducing mastectomy: impact of PREDICT and BOADICEA computations},
url = {http://dx.doi.org/10.1245/s10434-018-6593-4},
volume = {25},
year = {2018}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Introduction.Patients with sporadic breast cancer (BC)have  low  contralateral  breast  cancer  risk  (CLBCR;approximately 0.7% per annum) and contralateral pro-phylactic mastectomy (CPM) offers no survival advantage.CPM with autologous reconstruction (AR) has majormorbidity and resource implications.Objective.The aim of this study was to review the impactof PREDICT survival estimates and lifetime CLBCRscores on decision making for CPM in patients with uni-lateral BC.Methods.Ofn= 272 consecutive patients undergoingmastectomy and AR, 252 were included. Five- and 10-yearsurvival was computed with the PREDICT(V2) onlineprognostication tool, using age and clinicopathologicalfactors. Based on family history (FH) and tumor biology,CLBCR was calculated using validated BODICEA web-based software. Survival scores were correlated againstCLBCR estimates to identify patients receiving CPM with‘low’ CLBCR (\30% lifetime risk) and poor prognosis (5-year  survival\80%).  Patients  with  ‘high’  CLBCRreceiving unilateral mastectomy (UM) were similarlyidentified (UK National Institute of Health and CareExcellence [NICE] criteria for CPM,C30% lifetime BCrisk). Justifications motivating CPM were investigated.Results.Of 252 patients, 215 had UM and 37 had bilateralmastectomy and AR. Only 23 (62%) patients receivingCPM fulfilled the NICE criteria. Of 215 patients, 5 (2.3%)failed to undergo CPM despite high CLBCR and goodprognosis. CPMs were performed, at the patient’s request,for no clear justification (n= 8), contralateral non-invasivedisease, and/or FH (n= 5), FH alone (n= 4) and ipsilateralcancer recurrence-related anxiety (n= 3).Conclusion.In the absence of prospective risk estimatesof CLBCR and prognosis, certain patients receive CPMand reconstruction despite modest CLBCR, yet a propor-tion of patients with good prognoses and substantial riskare not undergoing CPM
AU  - Leff,DR
AU  - de,Silva T
AU  - Henry,F
AU  - Thiruchelvam,P
AU  - Hadjiminas,D
AU  - Al-Mufti,R
AU  - Hogben,K
AU  - Hunter,J
AU  - Wood,S
AU  - Jalalli,N
DO  - 10.1245/s10434-018-6593-4
EP  - 3063
PY  - 2018///
SN  - 1068-9265
SP  - 3057
TI  - Streamlining decision making in contralateral risk-reducing mastectomy: impact of PREDICT and BOADICEA computations
T2  - Annals of Surgical Oncology
UR  - http://dx.doi.org/10.1245/s10434-018-6593-4
UR  - https://link.springer.com/article/10.1245%2Fs10434-018-6593-4
UR  - http://hdl.handle.net/10044/1/61054
VL  - 25
ER  -
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