Procedure reduces risk of death for women with BRCA1 breast cancer
Procedure reduces risk of death for women with BRCA1 breast cancer
3 Jun 2014
A bilateral salpingo-oophorectomy (surgical removal of ovaries and fallopian tubes) reduced the risk of death for women with BRCA1-associated breast cancer.
Reduction of risk by 37-48% in case of BRCA1 gene mutations
In a cohort of nearly 700 breast cancer patients, having the procedure was associated with a 37% reduction in the risk of death, according to Kelly Metcalfe, RN, PhD, of the University of Toronto. But the benefit was entirely among women whose breast cancers were associated with mutations in the BRCA1 gene, where the risk reduction reached 48%, Metcalfe said at the annual meeting of the American Society of Clinical Oncology.
On the other hand, the procedure does not appear to improve survival in women whose cancer is associated with mutations in the BRCA2 gene, Metcalfe said.
One implication for clinicians is that there is value in performing a genetic test at the time of breast cancer diagnosis, she said, since it may lead to a decision that is potentially life-saving.
Indeed, salpingo-oophorectomy is a "major driver" of the need for BRCA1 and BRCA2 testing, commented Mark Robson, MD, of Memorial Sloan-Kettering Cancer Center in New York City, in a formal discussion after the presentations.
But, he noted, the evidence for a benefit (a lower risk of a second breast cancer and of breast cancer-specific death) comes mainly from nonrandomized trials, with a potential for confounding.
Moreover, an association with decreased risk doesn't mean the procedure causes that drop in risk, he said.
"Pragmatically," he said, "I'm not sure that it matters." The proven reduction in the risk of ovarian and fallopian tube cancers is itself "sufficient justification" for the procedure in affected women, Robson added. However justified, he said, "this is not a trivial intervention."
He noted that, in a separate paper presented at the meeting, Susan Domchek, MD, of the University of Pennsylvania in Philadelphia, and colleagues had documented a range of negative symptoms along "psychological, vasomotor, sexual function, and potential cognitive axes" that affect women who have had the procedure.
In addition, he said, there is evidence of long-term health consequences in young women who have the procedure, including bone health, cardiovascular mortality, cognitive dysfunction, and possibly overall mortality. "While this doesn't necessarily argue against doing an oophorectomy for cancer prevention," he said, "it does certainly mean that we have to be aware and monitor those women ... for these complications."
676 women with stage 1 & 2 breast cancer
Metcalfe and colleagues studied outcomes for 676 women with stage 1 and 2 breast cancer who were members of BRCA1 and BRCA2 kindreds and who had not had an oophorectomy before their cancer diagnosis.
With an average follow-up of 12.5 years, they found that 407 women had an oophorectomy with a mean time between diagnosis and the procedure of 6.4 years.
Altogether, 127 women died of breast cancer during follow-up, and 10-year survival was 84% and 87.5% for BRCA1 and BRCA2 women, respectively, Metcalfe reported.
The only other factor that predicted survival was being estrogen receptor-negative, she said.
Within the BRCA1 group, 77 women had the procedure within 2 years of diagnosis, and they were significantly less likely to die than those who did not have an oophorectomy, she added. Ten-year survival was 89.2% compared with 63.9% for women who did not have the procedure.
Source: MedPage Today