When Is a Little Breast Tissue Too Much?

When Is a Little Breast Tissue Too Much? Oncologic Safety of Prophylactic Nipple-Sparing Mastectomy in Patients With BRCA Mutations Original Investigation Research radiotherapy: a single center study at a Japanese 27. Stolier AJ, Wang J. Terminal duct lobular units 30. Torresan RZ, dos Santos CC, Okamura H, institution. Med Oncol. 2013;30(1):481. are scarce in the nipple: implications for Alvarenga M. Evaluation of residual glandular tissue prophylactic nipple-sparing mastectomy: terminal after skin-sparing mastectomies. Ann Surg Oncol. 25. Reynolds C, Davidson JA, Lindor NM, et al. duct lobular units in the nipple. Ann Surg Oncol. 2005;12(12):1037-1044. Prophylactic and therapeutic mastectomy in BRCA 2008;15(2):438-442. mutation carriers: can the nipple be preserved? 31. Wei CH, Scott AM, Price AN, et al. Psychosocial Ann Surg Oncol. 2011;18(11):3102-3109. 28. Askew JB Jr. Nipple micro-anatomy: ductal and sexual well-being following nipple-sparing epithelial types. J Am Coll Surg. 2012;214(3):377. mastectomy and reconstruction. Breast J. 2016;22 26. Rosen PP, Tench W. Lobules in the nipple: (1):10-17. frequency and significance for breast cancer 29. Chiba A, Jakub JW, Hieken TJ. Nipple-sparing treatment. Pathol Annu. 1985;20(pt 2):317-322. mastectomy: to spare or not to spare? Curr Surg Rep. 2016;4(5):17. doi:10.1007/s40137-016-0138-1 Invited Commentary Nipple-Sparing Risk-Reducing Mastectomy in BRCA Carriers Helen M. Johnson, MD; Jan H. Wong, MD Whether a proportional reduction in the volume of breast tis- els, up to 22 breast cancers would have been predicted to have sue proportionately reduces the risk of developing breast can- been diagnosed in their cohort. cer has been seriously debated in light of the recognition that Can this risk reduction be attributed solely to reduction in most patients undergoing pro- the number of breast cancer cells? All of these individuals were phylactic mastectomy have re- known BRCA carriers, and it is likely many had risk-reducing sidual breast tissue, includ- salpingo-oophorectomy. What, if any, effect this may have on the Related article page 123 ing terminal ductal units in the risk of developing breast cancer was not examined in this report. 1,2 3 skin flaps. Animal studies from 1986 suggested that the risk Although it seems intuitive that reducing the volume of of developing mammary tumors was not proportionately re- breast tissue would likely reduce the risk of developing breast duced by the amount of breast tissue removed. Thus, it was rec- cancer, BRCA carriers have germline mutations. Any residual ommended that if absolute protection was desired, a total mas- breast tissue remains at the same inherent risk of developing tectomy, including the nipple-areolar complex, was required. breast cancer. BRCA mutations result in potentially harmful 4,5 However, several observational studies have shown a breaks in DNA strands that can promote genomic instability greater than 90% reduction in the risk of developing breast can- and lead to cancer. Does the reduction in the number of breast cer in women who underwent prophylactic mastectomy, usu- cancer cells at risk simply represent a reduction in the statis- ally either total mastectomy or skin-sparing mastectomy. Given tical chance of a harmful event occurring? If so, might a lon- the superior cosmetic results of nipple-sparing mastectomy ger period of follow-up demonstrate just a delay in the future (NSM) with immediate reconstruction, NSM has become an development of breast cancer after a statistical increase in the increasingly popular risk-reduction strategy. number of harmful events attains a certain threshold? The re- 7 7 The study by Jakub and colleagues demonstrates the ben- port by Jakub and colleagues is reassuring that, at least in the efit of risk-reducing surgery extended to patients with known short-term, NSM provides substantial risk reduction in BRCA BRCA gene mutations and who have undergone NSM. In this mutation carriers. Because many of these procedures are per- study, no breast cancer events occurred in patients who un- formed in younger individuals with a substantial future cu- derwent bilateral risk-reducing NSM at a median follow-up of mulative risk of developing breast cancer, continued and long- 36 months, a period in which using several predictive mod- term follow-up is critical. ARTICLE INFORMATION after skin-sparing mastectomies. Ann Surg Oncol. 5. Hartmann LC, Sellers TA, Schaid DJ, et al. 2005;12(12):1037-1044. Efficacy of bilateral prophylactic mastectomy in Author Affiliations: Department of Surgery, BRCA1 and BRCA2 gene mutation carriers. J Natl Brody School of Medicine, East Carolina University, 2. Goldman LD, Goldwyn RM. Some anatomical Cancer Inst. 2001;93(21):1633-1637. Greenville, North Carolina. considerations of subcutaneous mastectomy. Plast Reconstr Surg. 1973;51(5):501-505. 6. Djohan R, Gage E, Gatherwright J, et al. Patient Corresponding Author: Jan H. Wong, MD, satisfaction following nipple-sparing mastectomy Department of Surgery, Brody School of Medicine, 3. Wong JH, Jackson CF, Swanson JS, et al. Analysis and immediate breast reconstruction: an 8-year East Carolina University, 600 Moye Blvd, of the risk reduction of prophylactic partial outcome study. Plast Reconstr Surg. 2010;125(3): Greenville, NC 27834 (wongj@ecu.edu). mastectomy in sprague-dawley rats with 818-829. 7,12-dimethylbenzanthracene-induced breast Published Online: September 13, 2017. cancer. Surgery. 1986;99(1):67-71. 7. Jakub JW, Peled AW, Gray RJ, et al. Oncologic doi:10.1001/jamasurg.2017.3438 safety of prophylactic nipple-sparing mastectomy 4. Rebbeck TR, Friebel T, Lynch HT, et al. Bilateral Conflict of Interest Disclosures: None reported. in a population with BRCA mutations: prophylactic mastectomy reduces breast cancer a multi-institutional study [published online risk in BRCA1 and BRCA2 mutation carriers: the REFERENCES September 13, 2017]. JAMA Surg. doi:10.1001 PROSE Study Group. J Clin Oncol. 2004;22(6): 1. Torresan RZ, dos Santos CC, Okamura H, /jamasurg.2017.3422 1055-1062. Alvarenga M. Evaluation of residual glandular tissue jamasurgery.com (Reprinted) JAMA Surgery February 2018 Volume 153, Number 2 129 © 2017 American Medical Association. All rights reserved. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Surgery American Medical Association

When Is a Little Breast Tissue Too Much?

Free
1 page

Loading next page...
1 Page
 
/lp/jama/when-is-a-little-breast-tissue-too-much-lTFXhdX4Hw
Publisher
American Medical Association
Copyright
Copyright 2017 American Medical Association. All Rights Reserved.
ISSN
2168-6254
eISSN
2168-6262
D.O.I.
10.1001/jamasurg.2017.3438
Publisher site
See Article on Publisher Site

Abstract

Oncologic Safety of Prophylactic Nipple-Sparing Mastectomy in Patients With BRCA Mutations Original Investigation Research radiotherapy: a single center study at a Japanese 27. Stolier AJ, Wang J. Terminal duct lobular units 30. Torresan RZ, dos Santos CC, Okamura H, institution. Med Oncol. 2013;30(1):481. are scarce in the nipple: implications for Alvarenga M. Evaluation of residual glandular tissue prophylactic nipple-sparing mastectomy: terminal after skin-sparing mastectomies. Ann Surg Oncol. 25. Reynolds C, Davidson JA, Lindor NM, et al. duct lobular units in the nipple. Ann Surg Oncol. 2005;12(12):1037-1044. Prophylactic and therapeutic mastectomy in BRCA 2008;15(2):438-442. mutation carriers: can the nipple be preserved? 31. Wei CH, Scott AM, Price AN, et al. Psychosocial Ann Surg Oncol. 2011;18(11):3102-3109. 28. Askew JB Jr. Nipple micro-anatomy: ductal and sexual well-being following nipple-sparing epithelial types. J Am Coll Surg. 2012;214(3):377. mastectomy and reconstruction. Breast J. 2016;22 26. Rosen PP, Tench W. Lobules in the nipple: (1):10-17. frequency and significance for breast cancer 29. Chiba A, Jakub JW, Hieken TJ. Nipple-sparing treatment. Pathol Annu. 1985;20(pt 2):317-322. mastectomy: to spare or not to spare? Curr Surg Rep. 2016;4(5):17. doi:10.1007/s40137-016-0138-1 Invited Commentary Nipple-Sparing Risk-Reducing Mastectomy in BRCA Carriers Helen M. Johnson, MD; Jan H. Wong, MD Whether a proportional reduction in the volume of breast tis- els, up to 22 breast cancers would have been predicted to have sue proportionately reduces the risk of developing breast can- been diagnosed in their cohort. cer has been seriously debated in light of the recognition that Can this risk reduction be attributed solely to reduction in most patients undergoing pro- the number of breast cancer cells? All of these individuals were phylactic mastectomy have re- known BRCA carriers, and it is likely many had risk-reducing sidual breast tissue, includ- salpingo-oophorectomy. What, if any, effect this may have on the Related article page 123 ing terminal ductal units in the risk of developing breast cancer was not examined in this report. 1,2 3 skin flaps. Animal studies from 1986 suggested that the risk Although it seems intuitive that reducing the volume of of developing mammary tumors was not proportionately re- breast tissue would likely reduce the risk of developing breast duced by the amount of breast tissue removed. Thus, it was rec- cancer, BRCA carriers have germline mutations. Any residual ommended that if absolute protection was desired, a total mas- breast tissue remains at the same inherent risk of developing tectomy, including the nipple-areolar complex, was required. breast cancer. BRCA mutations result in potentially harmful 4,5 However, several observational studies have shown a breaks in DNA strands that can promote genomic instability greater than 90% reduction in the risk of developing breast can- and lead to cancer. Does the reduction in the number of breast cer in women who underwent prophylactic mastectomy, usu- cancer cells at risk simply represent a reduction in the statis- ally either total mastectomy or skin-sparing mastectomy. Given tical chance of a harmful event occurring? If so, might a lon- the superior cosmetic results of nipple-sparing mastectomy ger period of follow-up demonstrate just a delay in the future (NSM) with immediate reconstruction, NSM has become an development of breast cancer after a statistical increase in the increasingly popular risk-reduction strategy. number of harmful events attains a certain threshold? The re- 7 7 The study by Jakub and colleagues demonstrates the ben- port by Jakub and colleagues is reassuring that, at least in the efit of risk-reducing surgery extended to patients with known short-term, NSM provides substantial risk reduction in BRCA BRCA gene mutations and who have undergone NSM. In this mutation carriers. Because many of these procedures are per- study, no breast cancer events occurred in patients who un- formed in younger individuals with a substantial future cu- derwent bilateral risk-reducing NSM at a median follow-up of mulative risk of developing breast cancer, continued and long- 36 months, a period in which using several predictive mod- term follow-up is critical. ARTICLE INFORMATION after skin-sparing mastectomies. Ann Surg Oncol. 5. Hartmann LC, Sellers TA, Schaid DJ, et al. 2005;12(12):1037-1044. Efficacy of bilateral prophylactic mastectomy in Author Affiliations: Department of Surgery, BRCA1 and BRCA2 gene mutation carriers. J Natl Brody School of Medicine, East Carolina University, 2. Goldman LD, Goldwyn RM. Some anatomical Cancer Inst. 2001;93(21):1633-1637. Greenville, North Carolina. considerations of subcutaneous mastectomy. Plast Reconstr Surg. 1973;51(5):501-505. 6. Djohan R, Gage E, Gatherwright J, et al. Patient Corresponding Author: Jan H. Wong, MD, satisfaction following nipple-sparing mastectomy Department of Surgery, Brody School of Medicine, 3. Wong JH, Jackson CF, Swanson JS, et al. Analysis and immediate breast reconstruction: an 8-year East Carolina University, 600 Moye Blvd, of the risk reduction of prophylactic partial outcome study. Plast Reconstr Surg. 2010;125(3): Greenville, NC 27834 (wongj@ecu.edu). mastectomy in sprague-dawley rats with 818-829. 7,12-dimethylbenzanthracene-induced breast Published Online: September 13, 2017. cancer. Surgery. 1986;99(1):67-71. 7. Jakub JW, Peled AW, Gray RJ, et al. Oncologic doi:10.1001/jamasurg.2017.3438 safety of prophylactic nipple-sparing mastectomy 4. Rebbeck TR, Friebel T, Lynch HT, et al. Bilateral Conflict of Interest Disclosures: None reported. in a population with BRCA mutations: prophylactic mastectomy reduces breast cancer a multi-institutional study [published online risk in BRCA1 and BRCA2 mutation carriers: the REFERENCES September 13, 2017]. JAMA Surg. doi:10.1001 PROSE Study Group. J Clin Oncol. 2004;22(6): 1. Torresan RZ, dos Santos CC, Okamura H, /jamasurg.2017.3422 1055-1062. Alvarenga M. Evaluation of residual glandular tissue jamasurgery.com (Reprinted) JAMA Surgery February 2018 Volume 153, Number 2 129 © 2017 American Medical Association. All rights reserved.

Journal

JAMA SurgeryAmerican Medical Association

Published: Feb 13, 2018

References

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off