DESCRIPTION: (Adapted from the Investigator's Abstract) Women with hereditary
breast cancer risk have limited options for management. Close cancer screening
or prophylactic mastectomy (PM) is most commonly utilized. Chemoprevention with
tamoxifen is another option, but data regarding long-term risk reduction are
incomplete and conflicting. Unfortunately, there are insufficient data
regarding the expected outcomes with either surveillance or PM. Breast cancers
on the chest wall have been documented following PM, developing in residual
glandular epithelium. Thus, the extent of risk reduction with PM, if any, has
been questioned. The program announcement "Clinical Epidemiology Studies in
Hereditary Breast/Ovarian Cancer" describes the "immediate need to address
these issues through retrospective studies based on existing resources". The
Mayo Clinic has served as a referral center for specialized surgeries,
including PM, for many years. They have access to two groups of high-risk women
who elected PM: unaffected women who have elected contralateral PM and women
treated with therapeutic mastectomy for their first breast cancer who elected
contralateral, unilateral PM. With the work proposed, the investigators will
clarify the magnitude of breast cancer risk reduction with PM using a
combination of methods, including standardized morbidity ratios using the Gail
and Anderson models to predict the expected number of events, and a relative
risk using sisters of women who had PM as a reference group. We will also
define short- and long-term complications following PM.
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