For women with breast cancer who opt for breast reconstruction using a flap of tissue abdomen requires genetic testing to detect high-risk mutations before surgery, concludes report in July issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).
Although only a small percentage of patients will test positive for BRCA or other high-risk mutations, genetic testing should be considered for all women in which a unilateral mastectomy (single) and a breast reconstruction with free abdominal flap (FFBR) is planned, according to the study carried out by Erez Dayan, MD, of Brigham & Women’s Hospital / Harvard Medical School and his colleagues, in a press release from Wolters Kluwer Health: Lippincott Williams and Wilkins.
The study included 160 women with breast cancer who had undergone a single (unilateral) mastectomy followed by breast reconstruction of the abdominal tissues between 2007 and 2016. This approach to reconstruction breast tissue uses a flap of tissue from the patient’s abdomen. Some women choose this approach to autologous reconstruction rather than breast reconstruction using implants.
Based on a personal or family history of breast cancer, 111 women followed the guidelines for genetic testing before mastectomy and breast reconstruction. In women with BRCA mutations, the risk of breast cancer is about five times higher than in women without mutations. Some of these at-risk women will have a “preventive” mastectomy to reduce their risk of breast cancer.
In the study, only about 56% of patients meeting the criteria for genetic testing were actually tested. Tests were also carried out on 10% of women who did not meet the criteria.
After an average follow-up of approximately 6 years, three patients developed opposite breast cancer. The three women demonstrated a high-risk mutation that could have been detected by genetic testing before surgery.
Thus, out of a total experience of 160 patients, harmful mutations after reconstruction were diagnosed in 1.9%, which led to a second mastectomy and reconstruction.
“These subsequent cancers resulted in additional surgeries after patients completed multi-stage reconstructions, creating a psychosocial and financial burden for patients and increasing costs to the health system” , said Dayan in his press release.
If women had known they were at high risk, they might have chosen to have a mastectomy and a risk-reducing reconstruction. This is especially important before breast reconstruction of abdominal tissue, as the abdominal donor site can only be used once.
Researchers also looked at the cost-effectiveness of expanding genetic testing for breast cancer. Testing all patients would have had an additional cost, but would have avoided the additional costs associated with treating the second cancer, reducing total costs by approximately $ 260,000. Dr. Dayan and his co-authors noted that insurance companies sometimes refuse coverage of genetic testing for breast cancer risk, but that the cost of testing has decreased in recent years, the statement said.
The study “supports the idea that genetic tests should be offered to all patients for whom unilateral breast reconstruction of the abdominal tissue is planned,” Dayan and his colleagues conclude in the press release. . “Plastic surgeons should play an active role in discussions with patients and their healthcare providers about the implications of genetic testing in these cases.”