Prophylactic Surgery Prevents Breast and Ovarian Cancer
Researchers have confirmed that prophylactic surgery can prevent breast and ovarian cancer among BRCA mutation carriers.
Timothy R. Rebbeck, PhD, of the University of Pennsylvania in Philadelphia, and colleagues have reported their findings in the Sept. 1 issue of the Journal of the American Medical Association, looking at the impact of prophylactic mastectomy and prophylactic salpingo-oophorectomy (removal of ovaries and fallopian tubes) on the development of cancer in women who are BRCA mutation carriers.
Women who are carriers of the BRCA1 or BRCA2(BRCA1/2) genes have a lifetime risk of breast cancer of 56-84%. They have an estimated ovarian cancer risks range from 36 - 63% for BRCA1 mutation carriers and 10-27% for BRCA2 mutation carriers.
Cancer risk-management for these BRCA mutation carriers have included risk-reducing salpingo-oophorectomy, risk-reducing mastectomy, annual cancer screening, and chemoprevention. Due to the lack of effective screening for ovarian cancer, salpingo-oophorectomy is strongly recommended once childbearing is complete.
The prospective, multicenter cohort study included 2482 women with BRCA1 or BRCA2 mutations ascertained between 1974 and 2008 at 22 clinical and research genetics centers in Europe and North America. The women were followed up until the end of 2009.
The reduction in cancer risk and the reduction in mortality.
Prophylactic mastectomy was associated with a decreased risk of breast cancer in BRCA1/2 mutation carriers. No breast cancer events were seen in 247 women who underwent risk-reducing mastectomy during 3 years of prospective follow-up. In contrast, 7% of women without risk-reducing mastectomy over a similar follow-up period were diagnosed with breast cancer
Only 38% of the 2482 participants had prophylactic salpingo-oophorectomy. These women had a significantly lower risk of both breast and ovarian cancer than women who did not have the surgery. They also reduced their risk of death.
Only 3% of women who had a prophylactic salpingo-oophorectomy died from any cause compared to 10% of those who did not have the surgery.
Among this same group of women, only 2% died of breast cancer compared to 6% of those who did not have the surgery. Only 0.4% died of ovarian cancer compared to 3% of those who did not have the surgery.
BRCA1 and BRCA2 mutations are the most common cause of hereditary breast cancer. Breast cancer in these women tend to occur at a younger age and are more often bilateral (in both breasts). Women with these inherited mutations also have an increased risk for developing other cancers, particularly ovarian cancer. Although in the U.S., BRCA mutations are found most often in Jewish women of Ashkenazi (Eastern Europe) origin, they can occur in any racial or ethnic group.
Domchek SM, et al "Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality" JAMA 2010; 304: 967-975.