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| Name | Class |
|---|---|
| Cancer Research Society | OTHER |
| Quebec Breast Cancer Foundation | OTHER |
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Patients with a germline pathogenic variant (GPV) in high-penetrance breast cancer susceptibility genes who are considering risk reducing mastectomy (RRM) often strongly desire to keep their nipple areola complex but inquire as to whether it is safe to do so. Relative to traditional or skin sparing mastectomy (SSM) techniques, nipple sparing mastectomy (NSM) is associated with improved psychosocial and sexual well-being and is significantly better for body image and reducing feelings of disfigurement.
Despite this, guidelines have yet to endorse the use of NSM over other RRM techniques, stating that more data and longer follow-up are needed to confirm it as a safe and effective strategy in GPV carriers. As NSM was not routinely adopted in high-risk patient populations undergoing RRM before 2010, there has been little data to inform the long-term oncologic safety of NSM. Well-designed studies have reported low to negligible rates of subsequent breast cancer in BRCA1/2 carriers following NSM, but have been limited by short median follow-up of less than 3 years. The current study is designed to confirm, with longer follow-up, prior findings on the oncologic safety of NSM in unaffected BRCA1/2 carriers. The investigators will also expand data to other high-penetrance GPV carriers, including PALB2, CDH1, PTEN, and TP53, for whom there is little-to-no data on outcomes following RRM.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Risk Reducing Mastectomy |
| ||
| Active surveillance |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Nipple Sparing Mastectomy (NSM) | Procedure | Nipple sparing mastectomy (NSM) is a surgical procedure which removes all macroscopic breast glandular tissue while retaining the skin as well as the nipple areola complex. |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of breast cancer following RRM | The primary outcome of interest is the incidence of breast cancer following RRM, defined as a histologically confirmed diagnosis of in situ or invasive breast cancer present within the nipple/areola, skin, subcutaneous tissue of the chest wall/reconstructed breast, or axillary lymph nodes. Patients with clinically occult invasive breast cancer diagnosed at the time of RRM (ie. on mastectomy pathology) will be excluded from the primary outcome analysis. | 10 years |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of RRM | To evaluate uptake of RRM versus active surveillance amongst an international cohort of unaffected women with high-penetrance GPVs in BRCA1/2, PALB2, CDH1, PTEN, or TP53 | 10 years |
| Incidence of post-operative complications |
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Inclusion Criteria:
Exclusion Criteria:
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Female patients aged 18-years or older with a confirmed GPV in BRCA1, BRCA2, PALB2, TP53, CDH1 or PTEN identified on pre-symptomatic genetic testing performed between January 1, 1994-June 30, 2024
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Stephanie Wong, MD | Contact | 5143408222 | sm.wong@mcgill.ca | |
| Sarah Sabboobeh, MSc | Contact | 5143408222 | sarah.sabboobe@ladydavis.ca |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Yale University | Recruiting | New Haven | Connecticut | 06510 | United States |
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| Skin-Sparing Mastectomy (SSM) | Procedure | Skin sparing mastectomy (SSM) is a procedure that removes the nipple and areola complex along with all visible macroscopic breast glandular tissue. |
|
| Total (Simple) Mastectomy | Procedure | Total (Simple) Mastectomy is a traditional mastectomy approach that removes the breast glandular tissue with a large overlying area of skin including the nipple and areola complex to allow for flat closure. |
|
To evaluate post-operative complications and supplemental surgery following NSM, SSM, and total mastectomy in those undergoing RRM
| 10 years |
| Incidence of pathologic outcomes following NSM | To evaluate pathologic outcomes following RRM, including the presence of high-risk lesions or occult in situ and/or invasive malignancy | 10 years |
| Number of participants using endocrine prevention | To explore the use of endocrine prevention in unaffected women with high-penetrance GPVs in BRCA1/2, PALB2, CDH1, PTEN, or TP53 who elect to undergo active surveillance | 10 years |
| Number of participants who have undergone pre-mastectomy imaging and post-mastectomy surveillance | To assess practices in pre-mastectomy imaging and post-mastectomy surveillance, including the number of participants who underwent preoperative MRI and mammography as well as post-mastectomy surveillance, including MRI, ultrasound and chest wall examination. | 10 years |
| Brigham and Women's Hospital - Dana-Farber Brigham Cancer Center | Not yet recruiting | Boston | Massachusetts | 02115 | United States |
|
| Memorial Sloan Kettering Cancer Center (MSKCC) | Not yet recruiting | New York | New York | 10065 | United States |
|
| University of Pennsylvania | Recruiting | Philadelphia | Pennsylvania | 19104-6205 | United States |
|
| University of Melbourne, Peter MacCallum Cancer Center | Not yet recruiting | Melbourne | Australia |
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| Ziekenhuis Aan de Stroom | Active, not recruiting | Antwerp | 2030 | Belgium |
| University of Calgary | Recruiting | Calgary | Alberta | T2N 4N1 | Canada |
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| Hamilton Health Sciences | Recruiting | Hamilton | Ontario | L8L 2X2 | Canada |
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| Women's College Hospital, University of Toronto | Not yet recruiting | Toronto | Ontario | Canada |
|
| Jewish General Hospital | Recruiting | Montreal | Quebec | H3T1E2 | Canada |
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| CHU de Quebec Université laval | Recruiting | Québec | Quebec | G1S 4L8 | Canada |
|
| Champalimaud Foundation, University of Lisbon | Not yet recruiting | Lisbon | Portugal |
|
| ID | Term |
|---|---|
| D016864 | Li-Fraumeni Syndrome |
| D006223 | Hamartoma Syndrome, Multiple |
| ID | Term |
|---|---|
| D009386 | Neoplastic Syndromes, Hereditary |
| D009369 | Neoplasms |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D049914 | DNA Repair-Deficiency Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D006222 | Hamartoma |
| D009378 | Neoplasms, Multiple Primary |
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| ID | Term |
|---|---|
| D015414 | Mastectomy, Subcutaneous |
| D008408 | Mastectomy |
| ID | Term |
|---|---|
| D013514 | Surgical Procedures, Operative |
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