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Record number:
2263
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Most recent risk assessment for breast cancer (Council of Europe, 2022): Newly diagnosed invasive breast cancer is an unacceptable risk for organ donation.
Breast cancer in the donor history: Organs from donors with invasive breast cancer might be accepted in selected cases after full treatment, complete remission and stringent follow-up for >5 years, depending on the initial stage and E/P and HER2/neu receptor expression, always bearing in mind the risk of transmission due to possible late metastases. Breast cancer stage 1 (AJCC, 8th edition) with curative surgery and cancer-free period >5 years seems to be associated with low to intermediate risk for transmission. All other invasive breast cancer stages are considered high-risk for transmission, independent of the presumed recurrence-free survival and treatment.
Most recent risk assessment for in situ carcinoma (Council of Europe, 2022): Breast low-grade in situ carcinoma non-may be considered minimal risk.
Time to detection:
Not applicable
Alerting signals, symptoms, evidence of occurrence:
Not applicable
Demonstration of imputability or root cause:
Not applicable
Imputability grade:
Not Assessable
Groups audience:
Keywords:
References:
Suggest new keywords:
Malignancy
Breast Cancer
Guidelines
Genetic predisposition
Therapy discussed
Review article
Deceased donor
Living donor
Reference attachment:
Suggest references:
Mathelin C, Domínguez-Gil B, Özmen V, Lodi M. European Guidelines Concerning the Transplantation of Organs from Donors with a History of Breast Cancer. Eur J Breast Health. 2023 Jan 1;19(1):106-109. doi: 10.4274/ejbh.galenos.2022.2022-12-3. PMID: 36605470; PMCID: PMC9806936.
Note:
First review AE 8/4/2024
Second review MN 8/11/24
Expert comments for publication:
Before deciding on the clinical use of organs obtained from a woman with a past or current history of breast cancer (BC) , the authors consider it essential to know the prognosis based on histological subtype, tumor grade, molecular characteristics, including expression of hormone receptors, human epidermal growth factor-receptor 2 and proliferation index, together with stage, completeness of treatment, time since the diagnosis and regularity and normality of follow-up. Tumor cell dormancy is a well-recognized phenomenon and metastasis shows variable time to become clinically detectable. So it is an issue when deciding on such donors if compared with the fixed risks of transmission which is generally considered unacceptable if > 10%. BC should only be accepted as organ donors with the highest caution and for very selected recipients. First, an extended cancer-free period (generally more than 5 years) is recommended. Secondly, careful clinical examination and imaging (TC with contrast), is necessary even after a long disease-free survival. Low and intermediate nuclear grade DCIS are considered as low risk for transmission. High nuclear grade DCIS and invasive BC stage 1A (T1N0, AJCC, 8th edition) with curative surgery and cancer-free period >5 years seems to be associated with low to intermediate risk of cancer transmission. All other invasive BC stages are considered as high-risk for transmission, independent of the presumed recurrence-free survival and treatment. Newly diagnosed invasive BC and past or present history of breast sarcoma are deemed to be of unacceptable risk for organ donation. In a donor with a known genetic predisposition, two safety precautions must be considered. First, a careful examination of the organs known to be at risk of developing malignancy must be performed, to ensure no active cancer is present (e.g., breasts and ovaries for BRCA1/2, breasts and stomach for CDH1). Secondly, transplanting an organ with a genetic risk of malignancy is not advised (e.g., uterus for PTEN). When possible, a local expert in cancer genetics should be consulted.