Effect of Oophorectomy on Survival After Breast Cancer in BRCA1 and BRCA2 Mutation Carriers | Breast Cancer | JAMA Oncology | JAMA Network
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Original Investigation
June 2015

Effect of Oophorectomy on Survival After Breast Cancer in BRCA1 and BRCA2 Mutation Carriers

Author Affiliations
  • 1Women’s College Research Institute, Toronto, Ontario, Canada
  • 2Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
  • 3Department of Preventive Medicine and Public Health, Creighton University School of Medicine, Omaha, Nebraska
  • 4Program in Cancer Genetics, McGill University, Montreal, Canada
  • 5Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 6British Columbia Cancer Agency, Vancouver, British Columbia, Canada
  • 7Department of Medicine, University of Chicago, Chicago, Illinois
  • 8Toronto Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
  • 9Department of Obstetrics and Gynecology, University Health Network, Toronto, Ontario, Canada
JAMA Oncol. 2015;1(3):306-313. doi:10.1001/jamaoncol.2015.0658
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.

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