Effect of oophorectomy on survival after breast cancer in BRCA1 and BRCA2 mutation carriers
Menée à partir de données portant sur 676 patientes présentant une mutation du gène BRCA1 ou BRCA2 et atteintes d'un cancer du sein de stade I ou II diagnostiqué entre 1975 et 2008, cette étude évalue l'effet d'une ovariectomie, réalisée après le diagnostic de la maladie, sur la survie à 20 ans des patientes
Importance : Women who carry a germline mutation in either the BRCA1 or BRCA2 gene face a lifetime risk of breast cancer of up to 70%, and once they receive a diagnosis of breast cancer, they face high risks of both second primary breast and ovarian cancers. Preventive bilateral salpingo-oophorectomy is recommended to women with a BRCA mutation at age 35 years or thereafter to prevent breast and ovarian cancer, but it is unclear whether oophorectomy has an impact on survival in women with BRCA-associated breast cancer. Objective : To estimate the impact of oophorectomy on survival in women with breast cancer with a BRCA1 or BRCA2 mutation. Design, Setting, and Participants : Retrospective analysis of patients selected by pedigree review of families who received counseling at 1 of 12 participating clinical genetics centers. Patients were 676 women with stage I or II breast cancer and a BRCA1 or BRCA2 mutation who were observed for up to 20 years after receiving a diagnosis between 1975 and 2008. Survival experience was compared for women who did and who did not undergo oophorectomy. Main Outcomes and Measures : In all analyses, the primary end point was death due to breast cancer. Results : Of the 676 women, 345 underwent oophorectomy after the diagnosis of breast cancer and 331 retained both ovaries. The 20-year survival for the entire patient cohort was 77.4%. The adjusted hazard ratio for death attributed to breast cancer in women who underwent oophorectomy was 0.38 (95% CI, 0.19-0.77; P = .007) for BRCA1 carriers and 0.57 (95% CI, 0.23-1.43; P = .23) for BRCA2 carriers. The hazard ratio for breast cancer–specific mortality was 0.76 (95% CI, 0.32-1.78; P = .53) for women with estrogen receptor–positive breast cancer and 0.07 (95% CI, 0.01-0.51; P = .009) for women with estrogen receptor–negative breast cancer. Conclusions and Relevance : Oophorectomy is associated with a decrease in mortality in women with breast cancer and a BRCA1 mutation. Women with estrogen receptor–negative breast cancer and a BRCA1 mutation should undergo oophorectomy shortly after diagnosis.
JAMA Oncology 2015