Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality.
Abstract | CONTEXT: OBJECTIVE: To estimate risk and mortality reduction stratified by mutation and prior cancer status. DESIGN, SETTING, AND PARTICIPANTS: Prospective, multicenter cohort study of 2482 women with BRCA1 or BRCA2 mutations ascertained between 1974 and 2008. 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 women were followed up until the end of 2009. MAIN OUTCOMES MEASURES: RESULTS: 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; 95% confidence interval [CI], 0.04-0.59) and those without prior breast cancer (6% vs 2%; HR, 0.28 [95% CI, 0.12-0.69]), and a lower risk of first diagnosis of breast cancer in BRCA1 mutation carriers (20% vs 14%; HR, 0.63 [95% CI, 0.41-0.96]) and BRCA2 mutation carriers (23% vs 7%; HR, 0.36 [95% CI, 0.16-0.82]). 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 [95% CI, 0.26-0.61]), breast cancer-specific mortality (6% vs 2%; HR, 0.44 [95% CI, 0.26-0.76]), and ovarian cancer-specific mortality (3% vs 0.4%; HR, 0.21 [95% CI, 0.06-0.80]). CONCLUSIONS:
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Authors | Susan M Domchek, Tara M Friebel, Christian F Singer, D Gareth Evans, Henry T Lynch, Claudine Isaacs, Judy E Garber, Susan L Neuhausen, Ellen Matloff, Rosalind Eeles, Gabriella Pichert, Laura Van t'veer, Nadine Tung, Jeffrey N Weitzel, Fergus J Couch, Wendy S Rubinstein, Patricia A Ganz, Mary B Daly, Olufunmilayo I Olopade, Gail Tomlinson, Joellen Schildkraut, Joanne L Blum, Timothy R Rebbeck |
Journal | JAMA
(JAMA)
Vol. 304
Issue 9
Pg. 967-75
(Sep 01 2010)
ISSN: 1538-3598 [Electronic] United States |
PMID | 20810374
(Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
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Topics |
- Adolescent
- Adult
- Aged
- Breast Neoplasms
(genetics, mortality, prevention & control)
- Cause of Death
- Fallopian Tubes
(surgery)
- Female
- Genes, BRCA1
- Genes, BRCA2
- Genetic Predisposition to Disease
- Genetic Testing
- Humans
- Mastectomy
- Middle Aged
- Mutation
- Ovarian Neoplasms
(genetics, mortality, prevention & control)
- Ovariectomy
- Prospective Studies
- Risk
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