Bilateral prophylactic oophorectomy and bilateral prophylactic mastectomy in a prospective cohort of unaffected BRCA1 and BRCA2 mutation carriers

Tara M. Friebel, Susan M. Domchek, Susan L. Neuhausen, Theresa Wagner, D. Gareth Evans, Claudine Isaacs, Judy E. Garber, Mary B. Daly, Rosalind Eeles, Ellen Matloff, Gail Tomlinson, Henry T. Lynch, Nadine Tung, Joanne L. Blum, Jeffrey Weitzel, Wendy S. Rubinstein, Patricia A. Ganz, Fergus Couch, Timothy R. Rebbeck

Research output: Contribution to journalArticle

57 Scopus citations

Abstract

Background: Women with BRCA1 or BRCA2 (BRCA1/2) mutations can reduce cancer incidence and mortality by using bilateral prophylactic oophorectomy (BPO) or bilateral prophylactic mastectomy (BPM). The availability of these risk-reduction strategies is an important consideration in the decision to undergo genetic testing. Patients and Methods: We evaluated the use of BPO and BPM in a prospective sample of 537 female BRCA1/2 mutation carriers from 17 centers in North America and Europe. These women were aged > 30 years, had no BPM, BPO, breast cancer, or ovarian cancer before the disclosure of their genetic test results and were followed for ≥ 6 months. Results: Bilateral prophylactic oophorectomy is used significantly more frequently than BPM (55% vs. 21%; P < .001). Bilateral prophylactic oophorectomy was more common among women age ≥ 40 years compared with women aged < 40 years (68% vs. 43%; P < .001) and among parous women compared with nulliparous women (60% vs. 39%; P < .001). There was no difference in BPM (P = .83) or BPO (P = .09) in BRCA1 versus BRCA2 carriers. Multivariate models identified age and parity as a predictor of BPO in BRCA1 carriers; age and ovarian cancer family history in BRCA2 carriers; parity and ovarian cancer family history as a predictor of BPM in BRCA1 carriers; and smoking and ovarian cancer family history in BRCA2 carriers. Conclusion: Bilateral prophylactic oophorectomy is more commonly used than BPM in unaffected BRCA1/2 mutation carriers. Parity, age, and family history can also influence BPO and BPM uptake. Consistent with current recommendations, BPO is used by the majority of parous women aged > 40 years.

Original languageEnglish (US)
Pages (from-to)875-882
Number of pages8
JournalClinical breast cancer
Volume7
Issue number11
DOIs
StatePublished - Dec 2007

Keywords

  • Genetic testing
  • Hereditary breast cancer
  • Surgery

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Friebel, T. M., Domchek, S. M., Neuhausen, S. L., Wagner, T., Evans, D. G., Isaacs, C., Garber, J. E., Daly, M. B., Eeles, R., Matloff, E., Tomlinson, G., Lynch, H. T., Tung, N., Blum, J. L., Weitzel, J., Rubinstein, W. S., Ganz, P. A., Couch, F., & Rebbeck, T. R. (2007). Bilateral prophylactic oophorectomy and bilateral prophylactic mastectomy in a prospective cohort of unaffected BRCA1 and BRCA2 mutation carriers. Clinical breast cancer, 7(11), 875-882. https://doi.org/10.3816/CBC.2007.n.053