Prophylactic surgery and cancer risk in BRCA1 and BRCA2 carriers

January 01, 0001

Prophylactic surgery and cancer risk in BRCA1 and BRCA2 carriers

BRCA1 and BRCA2 mutations pose a markedly increased risk for breast and ovarian cancers in carriers. Prophylactic mastectomy and salpingo- oophorectomy are opted for with some of these patients to reduce their risks of breast and ovarian cancer. These US and European researchers performed a prospective, multicenter cohort study of women with BRCA1 or BRCA2 mutations (n=2482). The study was conducted at 22 clinical and research genetics centers in Europe and North America to assess the relationship of risk- reducing mastectomy or salpingo-oophorectomy with cancer outcomes.

The researchers found: "No breast cancers were diagnosed in the 247 women with risk-reducing mastectomy compared with 98 women of 1372 diagnosed with breast cancer who did not have risk-reducing mastectomy. Compared with women who did not undergo risk-reducing salpingo-oophorectomy, women who underwent salpingo-oophorectomy had a lower risk of ovarian cancer, including those with prior breast cancer (6% vs 1%, respectively, hazard ratio {HR} 0.14) and those without prior breast cancer (6% vs 2%, HR 0.28), and a lower risk of first diagnosis of breast cancer in BRCA1 mutation carriers (20% vs 14%, HR, 0.63) and BRCA2 mutation carriers (23% vs 7%, HR 0.36). Compared with women who did not undergo risk-reducing salpingo-oophorectomy, undergoing salpingo-oophorectomy was associated with lower all-cause mortality (10% vs 3%, HR 0.40), breast cancer-specific mortality (6% vs 2%, HR 0.44),and ovarian cancer-specific mortality (3% vs 0.4%, HR 0.21)."

The researchers concluded: "Among a cohort of women with BRCA1 and BRCA2 mutations, the use of risk-reducing mastectomy was associated with a lower risk of breast cancer. Risk-reducing salpingo-oophorectomy was associated with a lower risk of ovarian cancer, first diagnosis of breast cancer, all-cause mortality, breast cancer-specific mortality, and ovarian cancer-specific mortality."

While perhaps not for everyone, this study demonstrates and quantifies a cancer risk benefit with prophylactic mastectomy and/or salpingo- oophorectomy in BRCA1 and BRCA2 carriers.


For the full abstract, click here.

JAMA 304(9:967-975, 1 September 2010 © 2010 American Medical Association
Association of Risk-Reducing Surgery in BRCA1 or BRCA2 Mutation Carriers With Cancer Risk and Mortality. Susan M. Domchek, Tara M. Friebel, Christian F. Singer, et al.

Category: X. Female Genital System, Breast. Keywords: mastectomy, salpingo-oophorectomy, BRCA1, BRCA2, cancer, prospective cohort trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 17 September 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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