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Survival after bilateral risk-reducing mastectomy in healthy BRCA1 and BRCA2 mutation carriers
Background In healthy BRCA1/2 mutation carriers, bilateral risk-reducing mastectomy (BRRM) strongly reduces the risk of developing breast cancer (BC); however, no clear survival benefit of BRRM over BC surveillance has been reported yet. Methods In this Dutch multicenter cohort study, we used multiv...
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Published in: | Breast cancer research and treatment 2019-10, Vol.177 (3), p.723-733 |
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Main Authors: | , , , , , , , , , , , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
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Summary: | Background
In healthy
BRCA1/2
mutation carriers, bilateral risk-reducing mastectomy (BRRM) strongly reduces the risk of developing breast cancer (BC); however, no clear survival benefit of BRRM over BC surveillance has been reported yet.
Methods
In this Dutch multicenter cohort study, we used multivariable Cox models with BRRM as a time-dependent covariable to estimate the associations between BRRM and the overall and BC-specific mortality rates, separately for
BRCA1
and
BRCA2
mutation carriers.
Results
During a mean follow-up of 10.3 years, 722 out of 1712
BRCA1
(42%) and 406 out of 1145
BRCA2
(35%) mutation carriers underwent BRRM. For
BRCA1
mutation carriers, we observed 52 deaths (20 from BC) in the surveillance group, and 10 deaths (one from BC) after BRRM. The hazard ratios were 0.40 (95% CI 0.20–0.90) for overall mortality and 0.06 (95% CI 0.01–0.46) for BC-specific mortality. BC-specific survival at age 65 was 93% for surveillance and 99.7% for BRRM. For
BRCA2
mutation carriers, we observed 29 deaths (7 from BC) in the surveillance group, and 4 deaths (no BC) after BRRM. The hazard ratio for overall mortality was 0.45 (95% CI 0.15–1.36). BC-specific survival at age 65 was 98% for surveillance and 100% for BRRM.
Conclusion
BRRM was associated with lower mortality than surveillance for
BRCA1
mutation carriers, but for
BRCA2
mutation carriers, BRRM may lead to similar BC-specific survival as surveillance. Our findings support a more individualized counseling based on BRCA mutation type. |
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ISSN: | 0167-6806 1573-7217 |
DOI: | 10.1007/s10549-019-05345-2 |