title: Substantial breast cancer risk reduction and potential survival benefit after bilateral mastectomy when compared with surveillance in healthy BRCA1 and BRCA2 mutation carriers: a prospective analysis.
abstract: BACKGROUND
  To prospectively assess the efficacy of bilateral risk-reducing mastectomy (BRRM) when compared with surveillance on breast cancer (BC) risk and mortality in healthy BRCA1 and BRCA2 mutation carriers.
  
  
  METHODS
  Five hundred and seventy healthy female mutation carriers (405 BRCA1, 165 BRCA2) were selected from the institutional Family Cancer Clinic database. Eventually, 156 BRCA1 and 56 BRCA2 mutation carriers underwent BRRM. The effect of BRRM versus surveillance was estimated using Cox models.
  
  
  RESULTS
  During 2037 person-years of observation (PYO), 57 BC cases occurred in the surveillance group versus zero cases during 1379 PYO in the BRRM group (incidence rates, 28 and 0 per 1000 PYO, respectively). In the surveillance group, four women died of BC, while one woman in the BRRM group presented with metastatic BC 3.5 years after BRRM (no primary BC), and died afterward, yielding a HR of 0.29 (95% CI 0.02-2.61) for BC-specific mortality.
  
  
  CONCLUSIONS
  In healthy BRCA1/2 mutation carriers, BRRM when compared with surveillance reduces BC risk substantially, while longer follow-up is warranted to confirm survival benefits.
authors.affiliation: Department of Medical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
authors.forename: B A M
authors.initials: BA
authors.lastname: Heemskerk-Gerritsen
authors.forename: M B E
authors.initials: MB
authors.lastname: Menke-Pluijmers
authors.forename: A
authors.initials: A
authors.lastname: Jager
authors.forename: M M A
authors.initials: MM
authors.lastname: Tilanus-Linthorst
authors.forename: L B
authors.initials: LB
authors.lastname: Koppert
authors.forename: I M A
authors.initials: IM
authors.lastname: Obdeijn
authors.forename: C H M
authors.initials: CH
authors.lastname: van Deurzen
authors.forename: J M
authors.initials: JM
authors.lastname: Collée
authors.forename: C
authors.initials: C
authors.lastname: Seynaeve
authors.forename: M J
authors.initials: MJ
authors.lastname: Hooning
mesh_terms: D000328:Adult; D019313:BRCA1 Protein / Q000235:genetics*; D024682:BRCA2 Protein / Q000235:genetics*; D001943:Breast Neoplasms / Q000453:epidemiology / Q000235:genetics* / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D013534:Survival
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human
keywords: BRCA; bilateral risk-reducing mastectomy; breast cancer; surveillance; survival