The risk of ovarian cancer after breast cancer in BRCA1 and BRCA2 carriers.
OBJECTIVE
To estimate the risk of ovarian cancer after a primary diagnosis of breast cancer among women with a BRCA1 or BRCA2 mutation and to identify host and treatment-related factors that might modify the risk.


METHODS
Patients were 491 women with stage I or stage II breast cancer, diagnosed from 1975 to 2000 and for whom a BRCA1 or BRCA2 mutation had been identified. Patients were followed from the initial diagnosis of breast cancer until either ovarian cancer, prophylactic oophorectomy, death, or 2002. The medical treatment records and pathology documents were reviewed. Information that was abstracted from the medical charts included date of breast cancer diagnosis, stage of disease, use of chemotherapy, use of radiation therapy, usage of tamoxifen, oophorectomy, recurrence, second malignancy, and vital status.


RESULTS
The 10-year actuarial risk of ovarian cancer after breast cancer was 12.7% for BRCA1 carriers and 6.8% for BRCA2 carriers (P = 0.03). The use of tamoxifen (OR = 1.79; P = 0.16) and chemotherapy (OR = 0.59; P = 0.15) did not significantly impact on the risk of subsequent ovarian cancer. Twenty-five percent of the deaths in women with stage I breast cancer were due to a subsequent ovarian cancer.


CONCLUSIONS
The high incidence of ovarian cancer suggests that oophorectomy should be recommended in female BRCA1 and BRCA2 mutation carriers with a diagnosis of breast cancer, especially those with stage I disease. Breast cancer systemic therapy did not significantly alter the risk of ovarian cancer.
Metcalfe
Kelly A
KA
Faculty of Nursing, University of Toronto, 50 St. George Street, Toronto, ON, Canada, M5S 3H4.
Lynch
Henry T
HT
Ghadirian
Parviz
P
Tung
Nadine
N
Olivotto
Ivo A
IA
Foulkes
William D
WD
Warner
Ellen
E
Olopade
Olufunmilayo
O
Eisen
Andrea
A
Weber
Barbara
B
McLennan
Jane
J
Sun
Ping
P
Narod
Steven A
SA
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy / Q000235:genetics*; D015331:Cohort Studies; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D018095:Germ-Line Mutation; D006801:Humans; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000235:genetics*; D010051:Ovarian Neoplasms / Q000235:genetics*; D012307:Risk Factors; D013629:Tamoxifen / Q000009:adverse effects / Q000627:therapeutic use
D013629:Tamoxifen