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


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 > or = 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 > or = 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.


CONCLUSIONS
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.
Friebel
Tara M
TM
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA. tfriebel@mail.med.upenn.edu
Domchek
Susan M
SM
Neuhausen
Susan L
SL
Wagner
Theresa
T
Evans
D Gareth
DG
Isaacs
Claudine
C
Garber
Judy E
JE
Daly
Mary B
MB
Eeles
Rosalind
R
Matloff
Ellen
E
Tomlinson
Gail
G
Lynch
Henry T
HT
Tung
Nadine
N
Blum
Joanne L
JL
Weitzel
Jeffrey
J
Rubinstein
Wendy S
WS
Ganz
Patricia A
PA
Couch
Fergus
F
Rebbeck
Timothy R
TR
D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics* / Q000517:prevention & control* / Q000601:surgery; D015331:Cohort Studies; D003657:Decision Making; D005060:Europe; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D009656:North America; D010052:Ovariectomy; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016387:Women's Health