Skip to main content
Erschienen in: Breast Cancer Research and Treatment 3/2013

01.12.2013 | Epidemiology

Risk-reducing surgery increases survival in BRCA1/2 mutation carriers unaffected at time of family referral

verfasst von: Sarah L. Ingham, Matthew Sperrin, Andrew Baildam, Gary L. Ross, Richard Clayton, Fiona Lalloo, Iain Buchan, Anthony Howell, D. Gareth R. Evans

Erschienen in: Breast Cancer Research and Treatment | Ausgabe 3/2013

Einloggen, um Zugang zu erhalten

Abstract

The aim of this study was to establish if risk-reducing surgery (RRS) increases survival among BRCA1/2 carriers without breast/ovarian cancer at the time of family referral. Female BRCA1/2 carriers were identified from the Manchester Genetic Medicine Database. Those patients alive and unaffected at the date of first family ascertainment were included in this study. Female first-degree relatives (FDRs) without predictive genetic testing who otherwise met eligibility criteria were also included. The effect of breast and ovarian RRS on survival was analysed. The survival experiences of RRS and non-RRS patients, stratified by BRCA status, were examined with Kaplan–Meier curves and contrasted using log-rank tests and Cox models. 691 female BRCA1/2 mutation carriers without breast or ovarian cancer at time of family ascertainment were identified; 346 BRCA1 and 345 BRCA2. 105 BRCA1 carriers and 122 BRCA2 carriers developed breast cancer during follow-up. The hazard of death was statistically significantly lower (P < 0.001) following RRS versus no RRS. 10-year survival for women having RRS was 98.9 % (92.4–99.8 %) among BRCA1 and 98.0 % (92.2–99.5 %) among BRCA2 carriers. This survival benefit with RRS remained significant after FDRs were added. Women who had any form of RRS had increased survival compared to those who did not have RRS; a further increase in survival was seen among women who had both types of surgery. However, formal evidence for a survival advantage from bilateral mastectomy alone requires further research.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Schrag D, Kuntz KM, Garber JE et al (1997) Decision analysis—effects of prophylactic mastectomy and oophorectomy on life expectancy among women with BRCA1 or BRCA2 mutations. N Engl J Med 336(20):1465–1471PubMedCrossRef Schrag D, Kuntz KM, Garber JE et al (1997) Decision analysis—effects of prophylactic mastectomy and oophorectomy on life expectancy among women with BRCA1 or BRCA2 mutations. N Engl J Med 336(20):1465–1471PubMedCrossRef
2.
Zurück zum Zitat Kurian AW, Munoz DF, Rust P et al (2012) An online tool to guide decisions for BRCA1/2 mutation carriers. J Clin Oncol 30(5):497–506PubMedCrossRef Kurian AW, Munoz DF, Rust P et al (2012) An online tool to guide decisions for BRCA1/2 mutation carriers. J Clin Oncol 30(5):497–506PubMedCrossRef
3.
Zurück zum Zitat Sigal BM, Munoz DF, Kurian AW et al (2012) A simulation model to predict the impact of prophylactic surgery and screening on the life expectancy of BRCA1 and BRCA2 mutation carriers. Cancer Epidemiol Biomarkers Prev 21(7):1066–1077PubMedCrossRef Sigal BM, Munoz DF, Kurian AW et al (2012) A simulation model to predict the impact of prophylactic surgery and screening on the life expectancy of BRCA1 and BRCA2 mutation carriers. Cancer Epidemiol Biomarkers Prev 21(7):1066–1077PubMedCrossRef
4.
Zurück zum Zitat Byrd LM, Shenton A, Maher ER et al (2008) Better life expectancy in women with BRCA2 compared to BRCA1 mutations is attributable to lower frequency, later onset and better cure rates of ovarian cancer. Cancer Epidemiol Biomarkers Prev 17(6):1535–1542PubMedCrossRef Byrd LM, Shenton A, Maher ER et al (2008) Better life expectancy in women with BRCA2 compared to BRCA1 mutations is attributable to lower frequency, later onset and better cure rates of ovarian cancer. Cancer Epidemiol Biomarkers Prev 17(6):1535–1542PubMedCrossRef
5.
Zurück zum Zitat Domchek SM, Friebel TM, Singer CF et al (2010) Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA 304(9):967–975PubMedCrossRef Domchek SM, Friebel TM, Singer CF et al (2010) Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA 304(9):967–975PubMedCrossRef
6.
Zurück zum Zitat Domchek S, Friebel-Klingner T, Neuhausen SL et al (2006) Mortality after bilateral salpingo-oophorectomy in BRCA1 and BRCA2 mutation carriers: a prospective cohort study. Lancet Oncol 7(3):223–229PubMedCrossRef Domchek S, Friebel-Klingner T, Neuhausen SL et al (2006) Mortality after bilateral salpingo-oophorectomy in BRCA1 and BRCA2 mutation carriers: a prospective cohort study. Lancet Oncol 7(3):223–229PubMedCrossRef
7.
Zurück zum Zitat Moller P, Borg A, Evans DG et al (2002) Survival in prospectively ascertained familial breast cancer: analysis of a series stratified by tumour characteristics, BRCA mutations and oophorectomy. Int J Cancer 101(6):555–559PubMedCrossRef Moller P, Borg A, Evans DG et al (2002) Survival in prospectively ascertained familial breast cancer: analysis of a series stratified by tumour characteristics, BRCA mutations and oophorectomy. Int J Cancer 101(6):555–559PubMedCrossRef
8.
Zurück zum Zitat Rebbeck TR, Lynch HT, Neuhausen SL et al (2002) Prevention and observation of Surgical End Points Study Group. Reduction in cancer risk after bilateral prophylactic BSO in BRCA1 and BRCA2 mutation carriers. N Engl J Med 346:1616–1622PubMedCrossRef Rebbeck TR, Lynch HT, Neuhausen SL et al (2002) Prevention and observation of Surgical End Points Study Group. Reduction in cancer risk after bilateral prophylactic BSO in BRCA1 and BRCA2 mutation carriers. N Engl J Med 346:1616–1622PubMedCrossRef
9.
Zurück zum Zitat Evans DG, Clayton R, Donnai P, Shenton A, Lalloo F (2009) Risk-reducing surgery for ovarian cancer: outcomes in 300 surgeries suggest a low peritoneal primary risk. Eur J Hum Genet 17(11):1381–1385PubMedCrossRef Evans DG, Clayton R, Donnai P, Shenton A, Lalloo F (2009) Risk-reducing surgery for ovarian cancer: outcomes in 300 surgeries suggest a low peritoneal primary risk. Eur J Hum Genet 17(11):1381–1385PubMedCrossRef
10.
Zurück zum Zitat Evans DGR, Baildam AD, Anderson E, Brain A, Shenton A, Vasen HFA, Eccles D, Lucassen A, Pichert G, Hamed H, Moller P, Maehle L, Morrison PJ, Stoppat-Lyonnet D, Gregory H, Smyth E, Niederacher D, Nestle-Krämling C, Campbell J, Hopwood P, Lalloo F, Howell A (2009) Risk reducing mastectomy: outcomes in 10 European Centres. J Med Genet 46(4):254–258PubMedCrossRef Evans DGR, Baildam AD, Anderson E, Brain A, Shenton A, Vasen HFA, Eccles D, Lucassen A, Pichert G, Hamed H, Moller P, Maehle L, Morrison PJ, Stoppat-Lyonnet D, Gregory H, Smyth E, Niederacher D, Nestle-Krämling C, Campbell J, Hopwood P, Lalloo F, Howell A (2009) Risk reducing mastectomy: outcomes in 10 European Centres. J Med Genet 46(4):254–258PubMedCrossRef
11.
12.
Zurück zum Zitat Sperrin M, Buchan I (2003) Modelling time to event with observations made at arbitrary times. Stat Med 32(1):99–109CrossRef Sperrin M, Buchan I (2003) Modelling time to event with observations made at arbitrary times. Stat Med 32(1):99–109CrossRef
13.
Zurück zum Zitat Smith A, Moran A, Boyd MC et al (2007) The trouble with phenocopies: are those testing negative for a family BRCA1/2 mutation really at population risk? J Med Genet 44(1):10–15PubMed Smith A, Moran A, Boyd MC et al (2007) The trouble with phenocopies: are those testing negative for a family BRCA1/2 mutation really at population risk? J Med Genet 44(1):10–15PubMed
14.
Zurück zum Zitat Evans DG, Shenton A, Woodward E et al (2008) Penetrance estimates for BRCA1 and BRCA2 based on genetic testing in a clinical cancer genetics service setting. BMC Cancer 8(1):155PubMedCrossRef Evans DG, Shenton A, Woodward E et al (2008) Penetrance estimates for BRCA1 and BRCA2 based on genetic testing in a clinical cancer genetics service setting. BMC Cancer 8(1):155PubMedCrossRef
15.
Zurück zum Zitat Grambsch P, Therneau T (1994) Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 81:515–526CrossRef Grambsch P, Therneau T (1994) Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 81:515–526CrossRef
16.
Zurück zum Zitat Evans DG, Gaarenstroom KN, Stirling D et al (2009) Screening for familial ovarian cancer: poor survival of BRCA1/2 related cancers. J Med Genet 46(9):593–597PubMedCrossRef Evans DG, Gaarenstroom KN, Stirling D et al (2009) Screening for familial ovarian cancer: poor survival of BRCA1/2 related cancers. J Med Genet 46(9):593–597PubMedCrossRef
17.
Zurück zum Zitat Passaperuma K, Warner E, Causer PA et al (2012) Long-term results of screening with magnetic resonance imaging in women with BRCA mutations. Br J Cancer 107(1):24–30PubMedCrossRef Passaperuma K, Warner E, Causer PA et al (2012) Long-term results of screening with magnetic resonance imaging in women with BRCA mutations. Br J Cancer 107(1):24–30PubMedCrossRef
18.
Zurück zum Zitat Chéreau E, Uzan C, Balleyguier C et al (2010) Characteristics, treatment, and outcome of breast cancers diagnosed in BRCA1 and BRCA2 gene mutation carriers in intensive screening programs including magnetic resonance imaging. Clin Breast Cancer 10(2):113–118PubMedCrossRef Chéreau E, Uzan C, Balleyguier C et al (2010) Characteristics, treatment, and outcome of breast cancers diagnosed in BRCA1 and BRCA2 gene mutation carriers in intensive screening programs including magnetic resonance imaging. Clin Breast Cancer 10(2):113–118PubMedCrossRef
19.
Zurück zum Zitat Møller P, Stormorken A, Jonsrud C, Holmen MM, Hagen AI, Clark N, Vabø A, Sun P, Narod SA, Mæhle L (2013) Survival of patients with BRCA1-associated breast cancer diagnosed in an MRI-based surveillance program. Breast Cancer Res Treat 139(1):155–161PubMedCrossRef Møller P, Stormorken A, Jonsrud C, Holmen MM, Hagen AI, Clark N, Vabø A, Sun P, Narod SA, Mæhle L (2013) Survival of patients with BRCA1-associated breast cancer diagnosed in an MRI-based surveillance program. Breast Cancer Res Treat 139(1):155–161PubMedCrossRef
20.
Zurück zum Zitat Evans DG, Howell A (2012) Are we ready for online tools in decision making for BRCA1/2 mutation carriers? J Clin Oncol 30(5):471–473PubMedCrossRef Evans DG, Howell A (2012) Are we ready for online tools in decision making for BRCA1/2 mutation carriers? J Clin Oncol 30(5):471–473PubMedCrossRef
21.
Zurück zum Zitat Hagen AI, Kvistad KA, Maehle L et al (2007) Sensitivity of MRI versus conventional screening in the diagnosis of BRCA-associated breast cancer in a national prospective series. Breast 16:367–374PubMedCrossRef Hagen AI, Kvistad KA, Maehle L et al (2007) Sensitivity of MRI versus conventional screening in the diagnosis of BRCA-associated breast cancer in a national prospective series. Breast 16:367–374PubMedCrossRef
22.
Zurück zum Zitat Kriege M, Brekelmans CT, Peterse H et al (2007) Tumor characteristics and detection method in the MRISC screening program for the early detection of hereditary breast cancer. Breast Cancer Res Treat 102:357–363PubMedCrossRef Kriege M, Brekelmans CT, Peterse H et al (2007) Tumor characteristics and detection method in the MRISC screening program for the early detection of hereditary breast cancer. Breast Cancer Res Treat 102:357–363PubMedCrossRef
23.
Zurück zum Zitat Kuhl CK, Schrading S, Leutner CC et al (2005) Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. J Clin Oncol 23:8469–8476PubMedCrossRef Kuhl CK, Schrading S, Leutner CC et al (2005) Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. J Clin Oncol 23:8469–8476PubMedCrossRef
24.
Zurück zum Zitat Leach MO, Boggis CR, Dixon AK et al (2005) Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet 365:1769–1778PubMedCrossRef Leach MO, Boggis CR, Dixon AK et al (2005) Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet 365:1769–1778PubMedCrossRef
25.
Zurück zum Zitat Trecate G, Vergnaghi D, Bergonzi S et al (2003) Breast MRI screening in patients with increased familial and/or genetic risk for breast cancer: a preliminary experience. Tumori 89:125–131PubMed Trecate G, Vergnaghi D, Bergonzi S et al (2003) Breast MRI screening in patients with increased familial and/or genetic risk for breast cancer: a preliminary experience. Tumori 89:125–131PubMed
26.
Zurück zum Zitat Stirling D, Evans DG, Pichert G et al (2005) Familial ovarian cancer screening: current protocols are ineffective in detecting early stage ovarian malignancy. J Clin Oncol 23(24):5588–5596PubMedCrossRef Stirling D, Evans DG, Pichert G et al (2005) Familial ovarian cancer screening: current protocols are ineffective in detecting early stage ovarian malignancy. J Clin Oncol 23(24):5588–5596PubMedCrossRef
27.
Zurück zum Zitat Sidon L, Ingham S, Clancy T et al (2012) Uptake of risk-reducing salpingo-oophorectomy in women carrying a BRCA1 or BRCA2 mutation: evidence for lower uptake in women affected by breast cancer and older women. Br J Cancer 106(4):775–779PubMedCrossRef Sidon L, Ingham S, Clancy T et al (2012) Uptake of risk-reducing salpingo-oophorectomy in women carrying a BRCA1 or BRCA2 mutation: evidence for lower uptake in women affected by breast cancer and older women. Br J Cancer 106(4):775–779PubMedCrossRef
28.
Zurück zum Zitat Evans DG, Lalloo F, Ashcroft L, Shenton A, Clancy T, Baildam AD, Brain A, Hopwood P, Howell A (2009) Uptake of risk reducing surgery in unaffected women at high risk of breast and ovarian cancer is risk, age and time dependent. Cancer Epidemiol Biomarkers Prev 18(8):2318–2324PubMedCrossRef Evans DG, Lalloo F, Ashcroft L, Shenton A, Clancy T, Baildam AD, Brain A, Hopwood P, Howell A (2009) Uptake of risk reducing surgery in unaffected women at high risk of breast and ovarian cancer is risk, age and time dependent. Cancer Epidemiol Biomarkers Prev 18(8):2318–2324PubMedCrossRef
Metadaten
Titel
Risk-reducing surgery increases survival in BRCA1/2 mutation carriers unaffected at time of family referral
verfasst von
Sarah L. Ingham
Matthew Sperrin
Andrew Baildam
Gary L. Ross
Richard Clayton
Fiona Lalloo
Iain Buchan
Anthony Howell
D. Gareth R. Evans
Publikationsdatum
01.12.2013
Verlag
Springer US
Erschienen in
Breast Cancer Research and Treatment / Ausgabe 3/2013
Print ISSN: 0167-6806
Elektronische ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-013-2765-x

Weitere Artikel der Ausgabe 3/2013

Breast Cancer Research and Treatment 3/2013 Zur Ausgabe

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.