J Breast Cancer.  2008 Dec;11(4):218-222. 10.4048/jbc.2008.11.4.218.

Contralateral Prophylactic Mastectomy and Prophylactic Salphingo-Oophorectomy in a BRCA1-Positive Breast Cancer Patient: A Case Report

Affiliations
  • 1Department of Surgery, Ajou University School of Medicine, Suwon, Korea. brcakorea@gmail.com
  • 2Department of Surgery, National University Bundang Hospital, Seongnam, Korea.
  • 3Department of Gynecology, National University Bundang Hospital, Seongnam, Korea.
  • 4Department of Psychiatry, National University Bundang Hospital, Seongnam, Korea.
  • 5Department of Plastic Surgery, National University Bundang Hospital, Seongnam, Korea.
  • 6Department of Radiology, National University Bundang Hospital, Seongnam, Korea.
  • 7Department of Internal Medicine, National University Bundang Hospital, Seongnam, Korea.
  • 8Department of Surgery, Seoul National University, College of Medicine, Seoul, Korea.

Abstract

Risk-reducing surgery is known as the most powerful preventive strategy for BRCA mutation carriers. This current case report represents the first documentation of the contralateral prophylactic mastectomy (CPM) and bilateral salphingo-oophorectomy (BSO) in a carrier of BRCA mutation in Korea. The patient was a 39-year-old woman who was seen in at a genetic counseling clinic for discussing of risk-reducing strategies for the breast and ovarian cancer. She presented at the age of 38 year with a 1.5 cm sized, grade 3, and ER/PR/HER2 negative infiltrating ductal carcinoma of the right breast. She was treated with wide local excision of the right breast and sentinel lymph node biopsy of the axilla. She was then treated with CAF (Cyclophosphamide+Doxorubicin+5-Fluorouracil) chemotherapy and radiation therapy. She was initially counseled at the time of surgery due to the family history of her mother, who suffered with breast cancer at the age of 58. After the completion of chemotherapy, we received the genetic test results and it was positive for the BRCA1 mutation (3746_3747insA). After a long discussion of cancer surveillance and risk-reducing options, she decided to undergo ipsilateral mastectomy and CPM and BSO. Before surgery, psychiatric consultation was done and questionnaires evaluating her depression, anxiety, body image, quality of life, and psychological distress were filled out. After discussion with the plastic surgeon, she decided to undergo delayed reconstruction of the breast. We performed endoscopic bilateral skin-sparing mastectomy and a laparoscopic bilateral salphingo-oophorectomy. There was no complication after surgery and the pathologic examination revealed no evidence of cancer in both breasts and ovaries. We think that CPM and BSO are feasible risk-reducing options for the breast cancer patients with the BRCA mutation in Korea.

Keyword

Prophylactic mastectomy; Prophylactic salphingo-oophorectomy; BRCA1 mutation

MeSH Terms

Adult
Anxiety
Axilla
Body Image
Breast
Breast Neoplasms
Carcinoma, Ductal
Depression
Female
Genetic Counseling
Humans
Korea
Mastectomy
Mothers
Nitriles
Ovarian Neoplasms
Ovary
Pyrethrins
Quality of Life
Sentinel Lymph Node Biopsy
Surveys and Questionnaires
Nitriles
Pyrethrins

Figure

  • Fig 1 Pedigree. It shows a typical pattern of autosomal dominant inheritance. Patient's mother and maternal aunt had breast cancer. Patient's maternal aunt and two brothers have also BRCA1 mutation. Arrow indicates proband.


Cited by  5 articles

Incidental Detection of Ductal Carcinoma In Situ of the Breast from Bilateral Prophylactic Mastectomy of Asymptomatic BRCA2 Mutation Carrier: A Case Report
Min-Young Choi, Jeong Eon Lee, Sung-Won Kim, Se Kyung Lee, Sung Mo Hur, Sangmin Kim, Min Young Koo, Soo Youn Bae, Jun-Ho Choe, Jung-Han Kim, Jee Soo Kim, Seok Jin Nam, Jung-Hyun Yang
J Breast Cancer. 2010;13(3):311-317.    doi: 10.4048/jbc.2010.13.3.311.

Single-Port Access Laparoscopic Prophylactic Bilateral Salpingo-Oophorectomy in BRCA-Positive Breast Cancer Patient: A Case Report
Tae-Joong Kim, Min-Young Choi, Se Kyung Lee, Sung Mo Hur, Sangmin Kim, Min Young Koo, Soo Youn Bae, Dong Hui Cho, Jun-Ho Choe, Jung-Han Kim, Jee Soo Kim, Byoung-Gie Kim, Duk-Soo Bae, Jeong Eon Lee, Seok Jin Nam, Jung-Hyun Yang
J Breast Cancer. 2010;13(4):437-442.    doi: 10.4048/jbc.2010.13.4.437.

Usage Patterns of Surveillance, Chemoprevention and Risk-Reducing Surgery in Korean BRCA Mutation Carriers: 5 Years of Experience at a Single Institution
Do Hoon Koo, Il Yong Chung, Eunyoung Kang, Sang Ah Han, Sung-Won Kim
J Breast Cancer. 2011;14(Suppl 1):S17-S23.    doi: 10.4048/jbc.2011.14.S.S17.

The Korean Hereditary Breast Cancer Study: Review and Future Perspectives
Eunyoung Kang, Sung-Won Kim
J Breast Cancer. 2013;16(3):245-253.    doi: 10.4048/jbc.2013.16.3.245.

Korean Hereditary Breast Cancer
Sung-Won Kim
J Korean Med Assoc. 2009;52(10):952-962.    doi: 10.5124/jkma.2009.52.10.952.


Reference

1. Claus EB, Schildkraut JM, Thompson WD, Risch NJ. The genetic attributable risk of breast and ovarian cancer. Cancer. 1996. 77:2318–2324.
Article
2. Friedman LS, Ostermeyer EA, Szabo CI, Dowd P, Lynch ED, Rowell SE, et al. Confirmation of BRCA1 by analysis of germline mutations linked to breast and ovarian cancer in ten families. Nat Genet. 1994. 8:399–404.
Article
3. Wooster R, Bignell G, Lancaster J, Swift S, Seal S, Mangion J, et al. Identification of the breast cancer susceptibility gene BRCA2. Nature. 1995. 378:789–792.
Article
4. Son BH, Ahn SH, Lee MH, Park SK, Kim SW. Korean Breast Cancer Society. Hereditary breast cancer in Korea: a review of the literature. J Breast Cancer. 2008. 11:1–9.
Article
5. Hartmann LC, Schaid DJ, Woods JE, Crotty TP, Myers JL, Arnold PG, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med. 1999. 340:77–84.
Article
6. Wainberg S, Husted J. Utilization of screening and preventive surgery among unaffected carriers of a BRCA1 or BRCA2 gene mutation. Cancer Epidemiol Biomarkers Prev. 2004. 13:1989–1995.
7. Narod SA, Offit K. Prevention and management of hereditary breast cancer. J Clin Oncol. 2005. 23:1656–1663.
Article
8. Pierce LJ, Levin AM, Rebbeck TR, Ben-David MA, Friedmann E, Solin LJ, et al. Ten-year multi-institutional results of breast-conserving surgery and radiotherapy in BRCA1/2-associated stage I/II breast cancer. J Clin Oncol. 2006. 24:2437–2443.
Article
9. Hahn HM, Yeom TH, Shin YW, Kim KH, Youn DJ, Jung KJ. A standardization study of beck depression inventory in Korea. J Korean Neuropsychiatr Assoc. 1986. 25:487–502.
10. Scheier MF, Carver CS, Bridges MW. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a re-evaluation of the Life Orientation Test. J Pers Soc Psychol. 1994. 67:1063–1078.
Article
11. Han DW, Lee CH, Tark JK. Standardization of Spielberger's anxiety test. accessed April 16, 2008. http://www.koreanpsychology.or.kr.
12. John EW. SF-36 Health Survey Update. accessed April 16, 2008. http://www.sf-36.org.
13. Thompson JK, van den Berg P, Roehrig M, Guarda AS, Heinberg LJ. The sociocultural attitudes towards appearance scale-3 (SATAQ-3): development and validation. Int J Eat Disord. 2004. 35:293–304.
Article
14. Cash TF. The Multidimensional Body-Self Relations Questionnaire Users' Manual. accessed April 16, 2008. http://www.body-images.com.
15. Green MJ, Biesecker BB, McInerney AM, Mauger D, Fost N. An interactive computer program can effectively educate patients about genetic testing for breast cancer susceptibility. Am J Med Genet. 2001. 103:16–23.
Article
16. Scheuer L, Kauff N, Robson M, Kelly B, Barakat R, Satagopan J, et al. Outcome of preventive surgery and screening for breast and ovarian cancer in BRCA mutation carriers. J Clin Oncol. 2002. 20:1260–1268.
Article
17. King MC, Wieand S, Hale K, Lee M, Walsh T, Owens K, et al. Tamoxifen and breast cancer incidence among women with inherited mutations in BRCA1 and BRCA2: National Surgical Adjuvant Breast and Bowel Project (NSABP-P1) Breast Cancer Prevention Trial. Jama. 2001. 286:2251–2256.
Article
18. Narod SA, Brunet JS, Ghadirian P, Robson M, Heimdal K, Neuhausen SL, et al. Tamoxifen and risk of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers: a case-control study. Hereditary Breast Cancer Clinical Study Group. Lancet. 2000. 356:1876–1881.
Article
19. Hereditary Breast and/or Ovarian Cancer: NCCN Practice Guidelines in Oncology. 2008. accessed June 5, 2008. v.1:http://www.nccn.org/professionals/physician_gls/PDF/genetics_screening.pdf.
20. Prevention of Breast Cancer: American Society of Clinical Oncology. accessed April 16, 2008. http://www.cancer.net/Cancer/cancer.html.
21. Metcalfe KA, Lubinski J, Ghadirian P, Lynch H, Kim-Sing C, Friedman E, et al. Predictors of contralateral prophylactic mastectomy in women with a BRCA1 or BRCA2 mutation: the Hereditary Breast Cancer Clinical Study Group. J Clin Oncol. 2008. 26:1093–1097.
Article
22. Boughey JC, Cormier JN, Xing Y, Hunt KK, Meric-Bernstam F, Babiera GV, et al. Decision analysis to assess the efficacy of routine sentinel lymphadenectomy in patients undergoing prophylactic mastectomy. Cancer. 2007. 110:2542–2550.
Article
23. Frost MH, Slezak JM, Tran NV, Williams CI, Johnson JL, Woods J, et al. Satisfaction after contralateral prophylactic mastectomy: the significance of mastectomy type, reconstructive complications, and body appearance. J Clin Oncol. 2005. 23:7849–7856.
Article
24. Kim KS, Kim SW, Lee MH, Ahn SH, Park SK. Korean Breast Cancer Society. Practice patterns of surgeons for the management of hereditary breast cancer in Korea. J Breast Cancer. 2008. 11:95–101.
Article
25. Kim EK, Kim KS, Park SK, Ahn SH, Lee MH, Kim SW, et al. The Korean Hereditary Breast Cancer (KOHBRA) Study: protocol review. J Breast Cancer. 2007. 10:241–247.
Article
Full Text Links
  • JBC
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr