Kelly Metcalfe1, Henry T Lynch2, William D Foulkes3, Nadine Tung4, Charmaine Kim-Sing5, Olufunmilayo I Olopade6, Andrea Eisen7, Barry Rosen8, Carrie Snyder2, Shelley Gershman1, Ping Sun9, Steven A Narod9. 1. Women's College Research Institute, Toronto, Ontario, Canada2Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada. 2. Department of Preventive Medicine and Public Health, Creighton University School of Medicine, Omaha, Nebraska. 3. Program in Cancer Genetics, McGill University, Montreal, Canada. 4. Beth Israel Deaconess Medical Center, Boston, Massachusetts. 5. British Columbia Cancer Agency, Vancouver, British Columbia, Canada. 6. Department of Medicine, University of Chicago, Chicago, Illinois. 7. Toronto Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada. 8. Department of Obstetrics and Gynecology, University Health Network, Toronto, Ontario, Canada. 9. Women's College Research Institute, Toronto, Ontario, Canada.
Abstract
IMPORTANCE: Women who carry a germline mutation in either the BRCA1 or BRCA2 gene face a lifetime risk of breast cancer of up to 70%, and once they receive a diagnosis of breast cancer, they face high risks of both second primary breast and ovarian cancers. Preventive bilateral salpingo-oophorectomy is recommended to women with a BRCA mutation at age 35 years or thereafter to prevent breast and ovarian cancer, but it is unclear whether oophorectomy has an impact on survival in women with BRCA-associated breast cancer. OBJECTIVE: To estimate the impact of oophorectomy on survival in women with breast cancer with a BRCA1 or BRCA2 mutation. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of patients selected by pedigree review of families who received counseling at 1 of 12 participating clinical genetics centers. Patients were 676 women with stage I or II breast cancer and a BRCA1 or BRCA2 mutation who were observed for up to 20 years after receiving a diagnosis between 1975 and 2008. Survival experience was compared for women who did and who did not undergo oophorectomy. MAIN OUTCOMES AND MEASURES: In all analyses, the primary end point was death due to breast cancer. RESULTS: Of the 676 women, 345 underwent oophorectomy after the diagnosis of breast cancer and 331 retained both ovaries. The 20-year survival for the entire patient cohort was 77.4%. The adjusted hazard ratio for death attributed to breast cancer in women who underwent oophorectomy was 0.38 (95% CI, 0.19-0.77; P = .007) for BRCA1 carriers and 0.57 (95% CI, 0.23-1.43; P = .23) for BRCA2 carriers. The hazard ratio for breast cancer-specific mortality was 0.76 (95% CI, 0.32-1.78; P = .53) for women with estrogen receptor-positive breast cancer and 0.07 (95% CI, 0.01-0.51; P = .009) for women with estrogen receptor-negative breast cancer. CONCLUSIONS AND RELEVANCE: Oophorectomy is associated with a decrease in mortality in women with breast cancer and a BRCA1 mutation. Women with estrogen receptor-negative breast cancer and a BRCA1 mutation should undergo oophorectomy shortly after diagnosis.
IMPORTANCE: Women who carry a germline mutation in either the BRCA1 or BRCA2 gene face a lifetime risk of breast cancer of up to 70%, and once they receive a diagnosis of breast cancer, they face high risks of both second primary breast and ovarian cancers. Preventive bilateral salpingo-oophorectomy is recommended to women with a BRCA mutation at age 35 years or thereafter to prevent breast and ovarian cancer, but it is unclear whether oophorectomy has an impact on survival in women with BRCA-associated breast cancer. OBJECTIVE: To estimate the impact of oophorectomy on survival in women with breast cancer with a BRCA1 or BRCA2 mutation. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of patients selected by pedigree review of families who received counseling at 1 of 12 participating clinical genetics centers. Patients were 676 women with stage I or II breast cancer and a BRCA1 or BRCA2 mutation who were observed for up to 20 years after receiving a diagnosis between 1975 and 2008. Survival experience was compared for women who did and who did not undergo oophorectomy. MAIN OUTCOMES AND MEASURES: In all analyses, the primary end point was death due to breast cancer. RESULTS: Of the 676 women, 345 underwent oophorectomy after the diagnosis of breast cancer and 331 retained both ovaries. The 20-year survival for the entire patient cohort was 77.4%. The adjusted hazard ratio for death attributed to breast cancer in women who underwent oophorectomy was 0.38 (95% CI, 0.19-0.77; P = .007) for BRCA1 carriers and 0.57 (95% CI, 0.23-1.43; P = .23) for BRCA2 carriers. The hazard ratio for breast cancer-specific mortality was 0.76 (95% CI, 0.32-1.78; P = .53) for women with estrogen receptor-positive breast cancer and 0.07 (95% CI, 0.01-0.51; P = .009) for women with estrogen receptor-negative breast cancer. CONCLUSIONS AND RELEVANCE: Oophorectomy is associated with a decrease in mortality in women with breast cancer and a BRCA1 mutation. Women with estrogen receptor-negative breast cancer and a BRCA1 mutation should undergo oophorectomy shortly after diagnosis.
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Authors: Koji Shindo; Jun Yu; Masaya Suenaga; Shahriar Fesharakizadeh; Christy Cho; Anne Macgregor-Das; Abdulrehman Siddiqui; P Dane Witmer; Koji Tamura; Tae Jun Song; Jose Alejandro Navarro Almario; Aaron Brant; Michael Borges; Madeline Ford; Thomas Barkley; Jin He; Matthew J Weiss; Christopher L Wolfgang; Nicholas J Roberts; Ralph H Hruban; Alison P Klein; Michael Goggins Journal: J Clin Oncol Date: 2017-08-02 Impact factor: 44.544
Authors: George U Eleje; Ahizechukwu C Eke; Ifeanyichukwu U Ezebialu; Joseph I Ikechebelu; Emmanuel O Ugwu; Onyinye O Okonkwo Journal: Cochrane Database Syst Rev Date: 2018-08-24