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

• Kim KS
• Kim S
• Han SA
• Kang E
• Jeon YT
• Ha TH
• Heo CY
• Jang M
• Kim SM
• Kim JH
• Lee KE
• Kim SW

• KMID: 2286589
• DOI: http://doi.org/10.4048/jbc.2008.11.4.218

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.

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