44 Variant of Uncertain Significance (VUS) Genetic Testing Results and Mastectomy Choice in Lumpectomy-Eligible Patients

Publication
Article
Miami Breast Cancer Conference® Abstracts Supplement41st Annual Miami Breast Cancer Conference® - Abstracts
Volume 38
Issue 4
Pages: 52-53

Background

Taken alone, germline genetic variants of uncertain significance (VUS) should not change surgical decision-making in patients with breast cancer (BC) based on current guidelines. We sought to evaluate whether VUS may be a driver of surgical choice in patients with BC who are lumpectomy eligible.

Methods

Patient and Clinical Characteristics by Surgical Choice

Patient and Clinical Characteristics by Surgical Choice

A single-institution retrospective analysis included patients with nonmetastatic BC who underwent lumpectomy or mastectomy from April 2020 to November 2021. We defined “lumpectomy eligible” as unilateral clinical T0-2 nonrecurrent disease in patients able to receive radiation. Patients with known pathogenic mutations were excluded. Descriptive analyses employed chi-square tests to compare patients undergoing lumpectomy or bilateral mastectomy (BLMast) for unilateral early-stage breast cancer, accounting for genetic testing receipt and results among all patients who were lumpectomy-eligible. Multivariate analysis to predict the likelihood of the primary outcome, mastectomy receipt, was limited to tested patients without pathogenic mutations using binomial logistic regression.

Results

Patient and Clinical Characteristics by Surgical Choice (cont.)

Patient and Clinical Characteristics by Surgical Choice (cont.)

Of 741 patients with BC who had surgical intervention, 549 (74.1%) were lumpectomy eligible and 326 received genetic testing (235 negative, 91 VUS). Overall, the median age was 55.0 (26-84). Of those tested, 206 underwent lumpectomy, and 58 underwent BLMast. Insurance type, race, ethnicity, language, income, tobacco use, marital status, and axillary management did not significantly differ between those who underwent lumpectomy or BLMast. Compared with patients who underwent a lumpectomy, a higher proportion of patients with a VUS result (39.7% vs 24.8%, P = .026), American Joint Committee on Cancer stage II disease (41.4% vs 31.1%, P = .023) and those with 2 or more MRI-recommended preoperative biopsies (31.3% vs 13.8%, P = .021) underwent BLMast. In addition, a significantly higher proportion of patients who underwent BLMast were younger than 50 years (63.8% vs 32.0%, P < .001).

Conclusions

VUS genetic testing results are more prevalent in lumpectomy-eligible patients choosing bilateral mastectomy, along with younger age, higher stage, and MRI biopsy receipt. The present analysis informs the implementation of robust but accessible genetic counseling education initiatives in breast surgical oncology to decrease unnecessary mastectomies in patients
with VUS.

Articles in this issue

38 Influence of Race on Attainment of Textbook Oncologic Outcome Following Modified Radical Mastectomy for Breast Cancer
38 Influence of Race on Attainment of Textbook Oncologic Outcome Following Modified Radical Mastectomy for Breast Cancer
39 The Influence of Reconstruction Type on Outcomes in Women Undergoing Mastectomy With Immediate Reconstruction:  A Nationwide Study
39 The Influence of Reconstruction Type on Outcomes in Women Undergoing Mastectomy With Immediate Reconstruction: A Nationwide Study
40 Ethnic Disparities in Complication Rates and Outcomes  of Nipple-Sparing Mastectomy:  A Comprehensive Analysis
40 Ethnic Disparities in Complication Rates and Outcomes of Nipple-Sparing Mastectomy: A Comprehensive Analysis
41 A Case Series of Sarcomas
41 A Case Series of Sarcomas
42 Transitional Lymphedema: Understanding the Temporal Dynamics Post-Axillary Surgery
42 Transitional Lymphedema: Understanding the Temporal Dynamics Post-Axillary Surgery
43 Impact of Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) on Postoperative Complication Rates in Mastectomy With Immediate Prosthetic-Based Breast Reconstruction
43 Impact of Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) on Postoperative Complication Rates in Mastectomy With Immediate Prosthetic-Based Breast Reconstruction
44 Variant of Uncertain Significance (VUS) Genetic Testing Results and Mastectomy Choice in Lumpectomy-Eligible Patients
44 Variant of Uncertain Significance (VUS) Genetic Testing Results and Mastectomy Choice in Lumpectomy-Eligible Patients
45 Application of the 7-Gene Biosignature in Palpable Versus Nonpalpable Ductal Carcinoma In Situ in a Black Patient Population: Does Palpability Suggest a More Aggressive Genomic Risk?
45 Application of the 7-Gene Biosignature in Palpable Versus Nonpalpable Ductal Carcinoma In Situ in a Black Patient Population: Does Palpability Suggest a More Aggressive Genomic Risk?
46 Comparative Analysis of Breast Conserving Therapy vs Mastectomy in Multifocal and Multicentric Breast Cancer: A Review of the Literature
46 Comparative Analysis of Breast Conserving Therapy vs Mastectomy in Multifocal and Multicentric Breast Cancer: A Review of the Literature
47 Can We Identify Factors That Predict DCIS Upgrade to Invasive Cancer at Mastectomy?
47 Can We Identify Factors That Predict DCIS Upgrade to Invasive Cancer at Mastectomy?
48 The Era ‘or Error’ of Second Localization Procedures
48 The Era ‘or Error’ of Second Localization Procedures
49 The Influence of Race on Complications in Breast Conservation Surgery: A Single Institution Study
49 The Influence of Race on Complications in Breast Conservation Surgery: A Single Institution Study
51 Ductal Carcinoma In Situ With Microinvasion on Biopsy—What Are the Predictors of Upstaging?
51 Ductal Carcinoma In Situ With Microinvasion on Biopsy—What Are the Predictors of Upstaging?
52 UK Experience of Non-Radioisotope, Non-Magnetic Guided Breast Wide Local Excision and Sentinel Node Biopsy
52 UK Experience of Non-Radioisotope, Non-Magnetic Guided Breast Wide Local Excision and Sentinel Node Biopsy
53 The Utility of Sentinel Lymph Node Biopsy in High-Grade Ductal Carcinoma In Situ
53 The Utility of Sentinel Lymph Node Biopsy in High-Grade Ductal Carcinoma In Situ
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