Risk of Contralateral Breast Cancer in BRCA Positive Patients

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • The annual risk for BRCA mutation carriers to develop breast cancer is:
    • Estimated to be 2.1%
  • The risk of contralateral breast cancer:
    • At 20 years post initial breast cancer diagnosis is:
      • 41% in BRCA1 mutation carriers
  • Age at diagnosis:
    • Does affect risk of contralateral breast cancer:
      • Women under 40 are at highest risk
  • Tamoxifen:
    • Has been shown to decrease the risk of contralateral breast cancer overall
  • Phillips et al:
    • Report that estrogen receptor status of the initial breast cancer diagnosis:
      • Did not affect contralateral breast cancer risk:
        • However the status was missing in over 50% of the cohort
    • In addition, women found to be at the highest risk were:
      • Those diagnosed with initial breast cancer under age 50
      • Those with 2 or more family members with history of breast cancer
      • Intact ovaries
        • The 15-year risk of contralateral breast cancer was 68% in these women:
        • These women should be counseled about risk reducing contralateral mastectomy and salpingo-oopherectomy
  • The strongest predictor of contralateral risk was oophorectomy
  • Contralateral prophylactic mastectomy is a controversial area in breast surgical oncology, and patient decision-making around this process continues to be studied
  • References
    • Metcalfe K, Gershman S, Lynch HT, et al. Predictors of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. Br J Cancer. 2011;104(9):1384–1392.
    • Phillips KA, Milne RL, Rookus MA, et al. Tamoxifen and risk of contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. J Clin Oncol. 2013;31(25):3091-3099.
    • Kuchenbaecker KB, Hopper JL, Barnes DR, et al. Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA. 2017;317(23):2402-2416.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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