Reasonable doubt? Determining the rate of non-benign pathology in patients undergoing contralateral prophylactic mastectomy for breast cancer

ABSTRACTS P20. Fertility preservation in women undergoing treatment for breast cancer in the UK: A questionnaire study Judy King1, Nicky Roche2, Melanie Davies3, Jacinta Abraham4, Alison Jones1 1 Royal Free Hampstead NHS Trust, London, UK 2 Royal Marsden Hospital, London, UK 3 University College Hospital NHS Trust, London, UK 4 Velindre Cancer Centre, Cardiff, UK Background: Fertility preservation is an important survivorship issue for women treated for breast cancer. Patients should be informed of the risk of infertility and offered referral to discuss fertility preservation options before systemic treatment commences. The aim of this work was to examine the referral practices of healthcare professionals who treat women with breast cancer in the UK. Method: An invitation to participate in a confidential, online questionnaire was emailed to surgeons, oncologists and clinical nurse specialists who manage patients with breast cancer in the UK. Results: 306 responses were received from surgeons, clinical nurse specialists and oncologists. The following factors influenced whether they discussed fertility preservation with patients: patient’s age (78%); TNM status (37.9%); concern that fertility preservation would delay chemotherapy (37.3%); whether the patient had children (33.5%) or a partner (24.7%); oestrogen receptor expression (22.6%), lack of knowledge regarding the available options (20.9%) and concern that the success of cancer treatment would be compromised (19.8%). 27% did not know whether fertility preservation was available on the NHS. Knowledge regarding the available options varied according to different members of the multi-disciplinary team, with Consultant oncologists more likely to know than Consultant surgeons or clinical nurse specialists (p<0.05). Conclusion: Although patients rate information on fertility as very important, healthcare professionals’ knowledge of and attitude towards fertility preservation in breast cancer patients was variable. Each breast MDT should have a fertility lead responsible for identifying patients suitable for early referral to a fertility specialist. P21. Non-invasive breast cancer is relevant to symptomatic breast services Gill Lawrence, Jackie Walton, Catherine Lagord, Shan Cheung, Olive Kearins West Midlands Cancer Intelligence Unit, Birmingham, UK Introduction: We examined the route of presentation of non-invasive breast cancers diagnosed in England in 2006 and 2007 to ascertain if noninvasive breast cancer is relevant to symptomatic services. Methods: Non-invasive breast cancers were identified from the data used in the first and second All Breast Cancer Reports. Results: 7,990 women were diagnosed with non-invasive breast cancer in 2006 and 2007. Overall, 10% of all new breast cancers were non-invasive. Although only 5% of breast cancers detected outside the NHS Breast Screening Programme (NHSBSP) were non-invasive compared with 19% of screen-detected breast cancers, 3,039 of the women (38%) presented outside the NHSBSP. Non-invasive breast cancers detected outside the NHSBSP had a higher mastectomy rate (47% compared to 28%), and a higher re-operation rate (27% compared to 19%). For women aged less than 50, the mastectomy rate in the non-screening cohort was 51%. Overall, 26% of women treated by mastectomy were known to have had immediate reconstruction. For women aged less than 50, the proportion was 46%. Conclusions: Non-invasive breast cancer is relevant to symptomatic breast services as it is a problem relating to the routine use of diagnostic radiology rather than screening per se. Cases presenting outside the NHSBSP were more likely to have repeat therapeutic procedures and mastectomies. Higher mastectomy rates in younger women may be due to availability of immediate reconstruction.

425 P22. Pre-operative MRI for Lobular Breast Cancer Andreas E. Shiatis, Itunuayo Ayeni, Vicky Stevenson, Chinedu Chianakwalam Breast Unit, William Harvey Hospital, Ashford, Kent, UK Introduction: NICE guidelines introduced in February 2009 recommend that patients with lobular breast cancer (LBC) should be offered preoperative MRI to measure the size of the tumour and exclude multifocal or contralateral disease. The aim of this study is to review the impact of MRI on the management of LBC in a District General Hospital. Methods: The database was retrospectively reviewed for all patients with LBC between August 2005 and June 2011. Their clinical, radiological and pathological data were analysed to establish where MRI altered the surgical management. Statistical analysis was done with the Chi-square test. Results: Of 162 cases with LBC, 41 had MRI scans: 12 out of 106 (11%) prior to and 29 out of 56 (54%) following the NICE guidelines. All had mammography and breast ultrasound. In only 3 cases (7%) did MRI change the management from breast conserving surgery to mastectomy by identifying a larger tumour than mammography and ultrasound. MRI did not detect any additional multifocal or contralateral disease. There was no significant difference in the mastectomy rates [MRI (39%) vs. non-MRI (45%) P¼0.17] or re-excision rates after breast conserving surgery [MRI (12%) vs. Non-MRI (9%) P¼0.96] Conclusion: The use of pre-operative MRI for LBC has increased since the NICE guidelines were introduced. MRI however influences the management in only a small proportion of cases and does not alter either the mastectomy or re-excision rates. P23. Reasonable doubt? Determining the rate of non-benign pathology in patients undergoing contralateral prophylactic mastectomy for breast cancer Sarah Rayne1, Bongani Mbatha1, Charles Serrurier1, Johan Slabbert1, Simon Naylor2, Carol Benn1 1 Netcare Breast Care Centre and University of the Witswatersrand, Johanneburg, South Africa 2 University of the Witswatersrand, Johannesburg, South Africa Introduction: There is a described trend for contralateral prophylactic mastectomy (CPM) in women diagnosed with a unilateral breast cancer and controversy surrounding the place of the procedure in breast oncological care. The aim of this study is to determine the presence of non-benign pathology in the contralateral breast in patients undergoing CPM. Method: Patients undergoing CPM for a first diagnosis of unilateral breast cancer in a single centre in Johannesburg, South Africa over a 10 year period were identified. Demographics and pre-operative radiological findings were recorded in addition to final histology of bilateral mastectomy specimens. Results: Over a ten year study period from Jan 2001 to May 2011, 351 breast cancer patients underwent CPM. Occult invasive malignancy was found in the CPM specimen in 16 (4.6%) patients. Preinvasive lesions were found in a further 17 (4.8%) and at least one high risk lesions were found in a further 60 (17.1%). In total, non-benign pathology was found in the CPM specimen of 92 (26.2%) of patients. Conclusion: In this breast centre, 9.4% of patients had a confirmed contralateral occult malignancy or pre-malignancy, and a further 17.1% had at least one high-risk lesion. Many of these lesions, if detected later in the contralateral breast of a breast cancer patient with unilateral mastectomy, would require invasive intervention through biopsy and surgery. The marked presence of occult non-benign pathology validates CPM for patients unwilling or unable to continue close breast surveillance due to any factor, including personal choice.