title: Effectiveness of Prophylactic Surgeries in BRCA1 or BRCA2 Mutation Carriers: A Meta-analysis and Systematic Review.
abstract: To systematically investigate the effectiveness of prophylactic surgeries (PS) implemented in women carrying BRCA1/2 mutations.
  
  
  
  The PubMed database was searched till August 2014 and 15 studies met the inclusion criteria. Fixed- or random-effects models were conducted according to study heterogeneity. We calculated the pooled relative risks (RR) for cancer risk or mortality along with 95% confidence intervals (CI).
  
  
  
  Prophylactic bilateral salpingo-oophorectomy (PBSO) and bilateral prophylactic mastectomy (BPM) were both associated with a decreased breast cancer risk in BRCA1/2 mutation carriers (RR, 0.552; 95% CI, 0.448-0.682; RR, 0.114; 95% CI, 0.041-0.317, respectively). Similar findings were observed in BRCA1 and BRCA2 mutation carriers separately. Moreover, contralateral prophylactic mastectomy (CPM) significantly decreased contralateral breast cancer incidence in BRCA1/2 mutation carriers (RR, 0.072; 95% CI, 0.035-0.148). Of note, PBSO was associated with significantly lower all-cause mortality in BRCA1/2 mutation carriers without breast cancer (HR, 0.349; 95% CI, 0.190-0.639) and those with breast cancer (HR, 0.432; 95% CI, 0.318-0.588). In addition, all-cause mortality was significantly lower for patients with CPM than those without (HR, 0.512; 95% CI, 0.368-0.714). However, BPM was not significantly associated with reduced all-cause mortality. Data were insufficient to obtain separate estimates of survival benefit with PS in BRCA1 or BRCA2 mutation carriers.
  
  
  
  BRCA1/2 mutation carriers who have been treated with PS have a substantially reduced breast cancer incidence and mortality. Clin Cancer Res; 22(15); 3971-81. ©2016 AACR.
authors.affiliation: Department of Urology, The Affiliated Cancer Hospital of Jiangsu Province of Nanjing Medical University, Nanjing, China. Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Intervention, Affiliated Hospital of Nantong University, Nantong, China.
authors.forename: Ran
authors.initials: R
authors.lastname: You
authors.affiliation: Department of Oncology, The Affiliated Cancer Hospital of Jiangsu Province of Nanjing Medical University, Nanjing, China.
authors.forename: Xinwei
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, China.
authors.forename: Congxin
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Urology, The Affiliated Cancer Hospital of Jiangsu Province of Nanjing Medical University, Nanjing, China.
authors.forename: Zicheng
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Department of Urology, The Affiliated Cancer Hospital of Jiangsu Province of Nanjing Medical University, Nanjing, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Urology, The Affiliated Cancer Hospital of Jiangsu Province of Nanjing Medical University, Nanjing, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Yu
authors.affiliation: Department of Urology, The Affiliated Cancer Hospital of Jiangsu Province of Nanjing Medical University, Nanjing, China.
authors.forename: Ting
authors.initials: T
authors.lastname: Xu
authors.affiliation: Department of Urology, The Affiliated Cancer Hospital of Jiangsu Province of Nanjing Medical University, Nanjing, China. caihongzhou@njmu.edu.cn zouqing_urology@sina.com.
authors.forename: Hongzhou
authors.initials: H
authors.lastname: Cai
authors.affiliation: Department of Urology, The Affiliated Cancer Hospital of Jiangsu Province of Nanjing Medical University, Nanjing, China. caihongzhou@njmu.edu.cn zouqing_urology@sina.com.
authors.forename: Qing
authors.initials: Q
authors.lastname: Zou
mesh_terms: D001943:Breast Neoplasms / Q000453:epidemiology / Q000235:genetics* / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006579:Heterozygote; D006801:Humans; D015994:Incidence; D009026:Mortality; D009154:Mutation; D017063:Outcome Assessment, Health Care; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000235:genetics / Q000517:prevention & control / Q000601:surgery; D010052:Ovariectomy; D000072036:Prophylactic Mastectomy; D065286:Prophylactic Surgical Procedures; D017594:Publication Bias; D012306:Risk