Erschienen in:
01.05.2016 | Review
Endocrine interventions in women with BRCA1/2 mutations
A systematic review
verfasst von:
Dr. Susanne Schüler-Toprak, PD Dr. Stephan Seitz, Prof. Dr. Olaf Ortmann
Erschienen in:
Die Gynäkologie
|
Ausgabe 5/2016
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Abstract
Background
One in eight women will be diagnosed with breast cancer and 5 % of all breast cancer cases are attributable to a mutation in BRCA1 or BRCA2. Lifetime risk of the general population is about 1.5 %. The probability of an underlying mutation depends on family history, histologic subtype and age at diagnosis. For healthy BRCA1/2 mutation carriers, ovarian cancer risk varies between 15 and 60 % depending of the mutation and modifying factors.
Objectives
The safety of endocrine interventions in BRCA1/2 mutation carriers has been investigated in numerous trials. In this article an update on the current knowledge on safety of oral contraception, hormone therapy and fertility treatment in BRCA1/2 mutation carriers is provided. Furthermore, options for primary prevention are discussed.
Materials and methods
A systematic search in the Medline literature database through PubMed using the terms “BRCA”, “famil*”, “breast cancer”, “ovarian cancer”, “oral contraception”, “fertility”, “fertility treatment”, “infertility”, “tamoxifen”, “raloxifene”, “chemoprevention”, “prevention”, “hormone”, “hormone treatment”, “hormone therapy”, “salpingo-oophorectomy” and “endocrine” was performed. Articles published between 1995 and 2015 were included.
Conclusions
Oral contraceptives seem to slightly increase the breast cancer risk of BRCA1/2 mutation carriers, but they also have a tremendous protective effect against ovarian cancer. Parity, breastfeeding and fertility treatment do not seem to influence cancer risk in these women. Hormone therapy should be offered after risk-reducing salpingo-oophorectomy to limit osteoporosis and cardiac mortality. Tamoxifen and raloxifene are effective for primary prevention of breast cancer in BRCA1/2 mutation carriers; however possible adverse effects must be considered.