title: Use of risk-reducing surgeries in a prospective cohort of 1,499 BRCA1 and BRCA2 mutation carriers.
abstract: Inherited mutations in BRCA1 or BRCA2 (BRCA1/2) confer very high risk of breast and ovarian cancers. Genetic testing and counseling can reduce risk and death from these cancers if appropriate preventive strategies are applied, including risk-reducing salpingo-oophorectomy (RRSO) or risk-reducing mastectomy (RRM). However, some women who might benefit from these interventions do not take full advantage of them. We evaluated RRSO and RRM use in a prospective cohort of 1,499 women with inherited BRCA1/2 mutations from 20 centers who enrolled in the study without prior cancer or RRSO or RRM and were followed forward for the occurrence of these events. We estimated the age-specific usage of RRSO/RRM in this cohort using Kaplan-Meier analyses. Use of RRSO was 45% for BRCA1 and 34% for BRCA2 by age 40, and 86% for BRCA1 and 71% for BRCA2 by age 50. RRM usage was estimated to be 46% by age 70 in both BRCA1 and BRCA2 carriers. BRCA1 mutation carriers underwent RRSO more frequently than BRCA2 mutation carriers overall, but the uptake of RRSO in BRCA2 was similar after mutation testing and in women born since 1960. RRM uptake was similar for both BRCA1 and BRCA2. Childbearing influenced the use of RRSO and RRM in both BRCA1 and BRCA2. Uptake of RRSO is high, but some women are still diagnosed with ovarian cancer before undergoing RRSO. This suggests that research is needed to understand the optimal timing of RRSO to maximize risk reduction and limit potential adverse consequences of RRSO.
authors.affiliation: Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, The University of Pennsylvania School of Medicine, 2 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA.
authors.forename: Xinglei
authors.initials: X
authors.lastname: Chai
authors.forename: Tara M
authors.initials: TM
authors.lastname: Friebel
authors.forename: Christian F
authors.initials: CF
authors.lastname: Singer
authors.forename: D Gareth
authors.initials: DG
authors.lastname: Evans
authors.forename: Henry T
authors.initials: HT
authors.lastname: Lynch
authors.forename: Claudine
authors.initials: C
authors.lastname: Isaacs
authors.forename: Judy E
authors.initials: JE
authors.lastname: Garber
authors.forename: Susan L
authors.initials: SL
authors.lastname: Neuhausen
authors.forename: Ellen
authors.initials: E
authors.lastname: Matloff
authors.forename: Rosalind
authors.initials: R
authors.lastname: Eeles
authors.forename: Nadine
authors.initials: N
authors.lastname: Tung
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Weitzel
authors.forename: Fergus J
authors.initials: FJ
authors.lastname: Couch
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hulick
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
authors.forename: Mary B
authors.initials: MB
authors.lastname: Daly
authors.forename: Olufunmilayo I
authors.initials: OI
authors.lastname: Olopade
authors.forename: Gail
authors.initials: G
authors.lastname: Tomlinson
authors.forename: Joanne L
authors.initials: JL
authors.lastname: Blum
authors.forename: Susan M
authors.initials: SM
authors.lastname: Domchek
authors.forename: Jinbo
authors.initials: J
authors.lastname: Chen
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Rebbeck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019313:BRCA1 Protein / Q000235:genetics*; D024682:BRCA2 Protein / Q000235:genetics*; D001943:Breast Neoplasms / Q000235:genetics / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018095:Germ-Line Mutation / Q000235:genetics*; D006579:Heterozygote; D006801:Humans; D008408:Mastectomy / Q000401:mortality* / Q000706:statistics & numerical data; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000235:genetics / Q000401:mortality / Q000601:surgery*; D010052:Ovariectomy / Q000401:mortality* / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D040242:Risk Reduction Behavior; D015996:Survival Rate; D055815:Young Adult
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human