Oophorectomy linked to decreased mortality in BRCA1 breast cancer

1. Oophorectomy was associated with decreased mortality in women with breast cancer and a BRCA1 mutation.

2. The survival benefit was particularly pronounced for women who had an oophorectomy within 2 years of breast cancer diagnosis.

Evidence Rating Level: 2 (Good)

Study Rundown: Female carriers of BRCA1 or BRCA2 gene mutations have up to a 70 percent lifetime risk of breast cancer. With a BRCA1 mutation, the lifetime risk of ovarian cancer is cited as high as 46 percent, while a BRCA2 mutation carries a lower risk of 17 to 23 percent. Because of these risks, it is recommended that women who are BRCA1 or 2 mutation carriers undergo prophylactic risk-reducing bilateral salpingo-oophorectomy at the completion of childbearing to prevent ovarian cancer. Smaller studies have suggested that among women in the general population who have been diagnosed with breast cancer, women who underwent oophorectomy experienced a lower risk of mortality. In the present study, researchers evaluated the impact of oophorectomy on survival in BRCA1 or 2 carriers with early-stage breast cancer.

Findings demonstrated that oophorectomy was associated with a significant reduction in mortality in women with a BRCA1 mutation, but not for women with a BRCA2 mutation. Authors suggest oophorectomy should be included in the treatment discussion at the time of breast cancer diagnoses in BRCA carriers. Strengths include a long follow-up of up to 20 years. Results are limited by retrospective design and variation in cancer treatment and survival over the 33-year study period. Future investigation in a larger population with more BRCA2 carriers would confirm the findings identified herein.

Click to read the study in JAMA Oncology

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Click to read an accompanying editorial in JAMA Oncology

Relevant Reading: Impact of oophorectomy on cancer incidence and mortality in women with a BRCA1 or BRCA2 mutation

In-Depth [retrospective cohort study]: Researchers reviewed the charts of 676 women with stage I or II breast cancer and a BRCA1 or BRCA2 mutation who received counseling at one of 12 clinical genetic centers. Follow-up was up to 20 years after diagnosis. The primary end point of death due to breast cancer was compared for women who did (n=345) and did not (n=331) undergo oophorectomy.

Women with a BRCA1 mutation who underwent oophorectomy experienced decreased mortality compared to women who retained their ovaries (aHR=0.38, p=0.007). A non-significant decrease in mortality was seen for women with BRCA 2 mutations. When oophorectomy was performed within 2 years of breast cancer diagnosis the decrease in mortality rate was more pronounced (HR=0.27, p=0.004). Overall 20-year survival was 77.4% and the mean time elapsed from breast cancer diagnosis to oophorectomy was 6.1 years.

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