Surgical and Financial Implications of Genetic Counseling and Requests for Concurrent Prophylactic Mastectomy.
Risk assessment evaluation and breast cancer (BRCA) testing can occur in situations where a woman considers herself to be at increased risk for developing breast cancer or her physicians, either during routine evaluation or after diagnosis of unilateral breast cancer, consider her to be at risk for harboring a genetic predisposition to breast malignancy. This study examined the impact of risk assessment counseling on trends in breast surgery and cost of care. A retrospective chart review was performed from January 1, 1999 to December 31, 2008 for women older than 18 years who underwent breast surgery for malignancy or prophylaxis, had at least 1-year follow-up, and underwent genetic counseling. From the total number of women treated at our institution who underwent unilateral or bilateral mastectomy, we identified 102 women who underwent genetic counseling and selected 199 patients who did not undergo counseling to create a 4:1 retrospective case-control study. Patients who underwent BRCA gene testing and/or counseling were compared with patients who did not (controls). The study was powered at 70%, and alpha was set at 0.05. Counseled patients were >9 times more likely to undergo bilateral mastectomies (odds ratio = 9.18). They were younger (46.4 vs. 61.8) and incurred higher total costs ($10,810 vs. $7,266) (P < 0.002). The same trend was observed in each group. In counseled and control groups, younger women chose bilateral mastectomies (mean 44.4; 55.5), whereas older women chose unilateral procedures (mean 49.8; 63.02) (P < 0.014). Total cost for bilateral mastectomies was greater than unilateral mastectomies for both groups. Of 55 counseled patients undergoing mastectomies (85 breasts), 78 (92%) breasts were reconstructed, whereas 113 (49%) of 230 breasts were reconstructed in the control group. There was a statistically significant association between counseling with BRCA testing and decision to undergo bilateral as opposed to unilateral mastectomies. Younger women were also more likely to choose bilateral mastectomies whether or not they underwent counseling. Furthermore, a greater proportion of counseled women who underwent reconstruction opted to have bilateral implants. At our institution, younger women tend to choose costlier options.
Published In/Presented At
Murphy, R., Adkinson, J., Namey, T., Eid, S., & Bleznak, A. (2010). Surgical and financial implications of genetic counseling and requests for concurrent prophylactic mastectomy. Annals Of Plastic Surgery, 64(5), 684-687. doi:10.1097/SAP.0b013e3181dba8dc
Presented at: The Northweastern Society for Plastic Surgeons 26th Annual Meeting, Charleston, SC. (September 2009)
Presented at: The American Society of Clinical Oncology (ASCO), San Francisco, CA. (October 8-10, 2009)
Presented at: The Keystone Meeting of the American College of Surgeons, Harrisburg, PA. (November 6, 2009)
Medical Specialties | Medicine and Health Sciences | Other Medical Specialties | Surgery
Department of Community Health and Health Studies, Department of Surgery, Department of Surgery Faculty