Oophorectomy and risk of contralateral breast cancer among BRCA1 and BRCA2 mutation carriers

Purpose Following a diagnosis of breast cancer, BRCA mutation carriers face an increased risk of developing a second (contralateral) cancer in the unaffected breast. It is important to identify predictors of contralateral cancer in order to make informed decisions about bilateral mastectomy. The imp...

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Bibliographic Details
Published in:Breast cancer research and treatment 2019-06, Vol.175 (2), p.443-449
Main Authors: Kotsopoulos, Joanne, Lubinski, Jan, Lynch, Henry T., Tung, Nadine, Armel, Susan, Senter, Leigha, Singer, Christian F., Fruscio, Robert, Couch, Fergus, Weitzel, Jeffrey N., Karlan, Beth, Foulkes, William D., Moller, Pal, Eisen, Andrea, Ainsworth, Peter, Neuhausen, Susan L., Olopade, Olufunmilayo, Sun, Ping, Gronwald, Jacek, Narod, Steven A.
Format: Article
Language:English
Subjects:
BRCA1 protein
BRCA2 protein
Breast cancer
Cancer
Cancer research
Development and progression
Diagnosis
Epidemiology
Gene mutations
Genetic aspects
Health aspects
Health risk assessment
Mastectomy
Medical colleges
Medicine
Medicine & Public Health
Mutation
Oncology
Oncology, Experimental
Ovariectomy
Risk factors
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Summary:Purpose Following a diagnosis of breast cancer, BRCA mutation carriers face an increased risk of developing a second (contralateral) cancer in the unaffected breast. It is important to identify predictors of contralateral cancer in order to make informed decisions about bilateral mastectomy. The impact of bilateral salpingo-oophorectomy (i.e., oophorectomy) on the risk of developing contralateral breast cancer is unclear. Thus, we conducted a prospective study of the relationship between oophorectomy and the risk of contralateral breast cancer in 1781 BRCA1 and 503 BRCA2 mutation carriers with breast cancer. Methods Women were followed from the date of diagnosis of their first breast cancer until the date of diagnosis of a contralateral breast cancer, bilateral mastectomy, date of death, or date of last follow-up. Cox proportional hazards regression was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of contralateral breast cancer associated with oophorectomy. Oophorectomy was included as a time-dependent covariate. We performed a left-censored analysis for those women who reported a primary breast cancer prior to study entry (i.e., from completion of baseline questionnaire). Results After an average of 9.8 years of follow-up, there were 179 (7.8%) contralateral breast cancers diagnosed. Oophorectomy was not associated with the risk of developing a second breast cancer (HR 0.92; 95% CI 0.68–1.25). The relationship did not vary by BRCA mutation type or by age at diagnosis of the first breast cancer. There was some evidence for a decreased risk of contralateral breast cancer among women with an ER-positive primary breast cancer, but this was based on a small number of events ( n  = 240). Conclusion Overall, our findings suggest that oophorectomy has little impact on the risk of contralateral breast cancer.
ISSN:0167-6806
1573-7217
1573-7217
DOI:10.1007/s10549-019-05162-7