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Breast Cancer Research and Treatment

, Volume 148, Issue 2, pp 397–406 | Cite as

Use of risk-reducing surgeries in a prospective cohort of 1,499 BRCA1 and BRCA2 mutation carriers

  • Xinglei Chai
  • Tara M. Friebel
  • Christian F. Singer
  • D. Gareth Evans
  • Henry T. Lynch
  • Claudine Isaacs
  • Judy E. Garber
  • Susan L. Neuhausen
  • Ellen Matloff
  • Rosalind Eeles
  • Nadine Tung
  • Jeffrey N. Weitzel
  • Fergus J. Couch
  • Peter J. Hulick
  • Patricia A. Ganz
  • Mary B. Daly
  • Olufunmilayo I. Olopade
  • Gail Tomlinson
  • Joanne L. Blum
  • Susan M. Domchek
  • Jinbo Chen
  • Timothy R. Rebbeck
Epidemiology

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.

Keywords

Risk reduction BRCA1 BRCA2 Surgical prevention Uptake 

Notes

Acknowledgments

The PROSE Consortium acknowledges the following centers and individuals who contributed to the present study: University of Vienna, Austria (Christian Singer); Beth Israel, Boston, MA (Nadine Tung); Baylor-Charles A. Sammons Cancer Center (Joanne L. Blum, Becky Althaus, Gabrielle Ethington, Estelle Brothers); City of Hope, Duarte, CA (Jeffrey Weitzel); Creighton University, Omaha, NE (Carrie Snyder, Henry T. Lynch, Patrice Watson); Dana-Farber Cancer Institute, Boston, MA (Katherine Corso, Kathryn Stoeckert, Judy E. Garber); NorthShore University HealthSystem, Evanston, IL (Peter J. Hulick, Christina Selkirk, Scott M. Weissman); Fox Chase Cancer Center, Philadelphia, PA (Mary B. Daly); Guy’s Hospital and St. Thomas Foundation Trust, London, UK (Gabriella Pichert, Caroline Langman, Leena da Silva); Georgetown University, Washington, DC (Camille Jasper, Claudine Isaacs); University of California, Los Angeles (Patricia A. Ganz, Joyce L. Seldon); Mayo Clinic College of Medicine, Rochester, MN (Fergus Couch); Netherlands Cancer Institute, Amsterdam, Netherlands (Marc van Beurden, Laura van ‘t Veer); The Institute of Cancer Research & Royal Marsden NHS Foundation Trust, London & Sutton (Rosalind Eeles, Elizabeth Bancroft, Elizabeth Page, Lucia D’Mello, Susan Shanley, Audrey Ardern-Jones, Elena Castro, Anita Mitra, Kelly Kohut, Jennifer Wiggins, The Carrier Clinic Collaborators); St. Mary’s Hospital, Manchester, UK (Gareth Evans, Fiona Lalloo); University of Texas-Southwestern, Dallas (n = 63, Gail Tomlinson); University of Chicago, Chicago, IL (Shelly Cummings, Olufunmilayo Olopade); University of Pennsylvania, Philadelphia, PA (Susan Domchek, Tara M Friebel, Timothy Rebbeck, Jill Stopfer, Jacquelyn Powers, Katherine Nathanson); University of Utah, Salt Lake City, UT and University of California, Irvine (Susan Neuhausen, Linda Steele); Women’s College Hospital, Toronto, CA (Steven A. Narod); Yale University, New Haven, CT (Ellen T. Matloff, Karina L. Brierly). This study was supported by grants from the Public Health Service (R01-CA164305 to XLC and JBC, R01-CA83855 and R01-CA102776 to TRR), The Basser Center for BRCA at the University of Pennsylvania (to TRR, SMD), Komen Foundation for the Cure (SMD), the Dana-Farber/Harvard Cancer Center SPORE in BC P50 CA-089393 (to JEG), the Department of Defense (DAMD-17-96-I-6088 to AKG; DAMD-17-94-J-4340 and DAMD-17-97-I-7112 to HTL), P30-CA51008-15 (to Georgetown University), The Utah Cancer registry (funded by Public Health Service Grant NO1-CN-6700) and the Utah State Department of Health, the Nebraska State Cancer and Smoking-Related Diseases Research Program (LB595 to HTL), P30-CA-16042 (to PAG), Cancer Research UK Grant Number C5047/A7357 (to RE), and NCI P30 CA51008-12 (to CI). OIO is Doris Duke Distinguished Clinical Scientist. RE acknowledges The Support of the NIHR to The Biomedical Research Centre at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust. Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under grant number RC4CA153828 (PI: J. Weitzel). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflict of interest

None.

Supplementary material

10549_2014_3134_MOESM1_ESM.docx (43 kb)
Supplementary material 1 (DOCX 43 kb)

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Xinglei Chai
    • 1
  • Tara M. Friebel
    • 1
    • 2
  • Christian F. Singer
    • 4
  • D. Gareth Evans
    • 5
  • Henry T. Lynch
    • 6
  • Claudine Isaacs
    • 7
  • Judy E. Garber
    • 8
  • Susan L. Neuhausen
    • 9
  • Ellen Matloff
    • 10
  • Rosalind Eeles
    • 11
    • 12
  • Nadine Tung
    • 13
  • Jeffrey N. Weitzel
    • 14
  • Fergus J. Couch
    • 15
  • Peter J. Hulick
    • 16
    • 17
  • Patricia A. Ganz
    • 18
  • Mary B. Daly
    • 19
  • Olufunmilayo I. Olopade
    • 20
  • Gail Tomlinson
    • 21
  • Joanne L. Blum
    • 22
  • Susan M. Domchek
    • 2
    • 3
  • Jinbo Chen
    • 1
  • Timothy R. Rebbeck
    • 1
    • 2
  1. 1.Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and BiostatisticsThe University of Pennsylvania School of MedicinePhiladelphiaUSA
  2. 2.Basser Center for BRCA and Abramson Cancer CenterThe University of Pennsylvania School of MedicinePhiladelphiaUSA
  3. 3.Department of MedicineThe University of Pennsylvania School of MedicinePhiladelphiaUSA
  4. 4.Division of Special GynecologyMedical University of ViennaViennaAustria
  5. 5.Department of Genomic Medicine, MAHSC, St. Mary’s HospitalUniversity of ManchesterManchesterUK
  6. 6.Creighton UniversityOmahaUSA
  7. 7.Lombardi Comprehensive Cancer CenterGeorgetown UniversityWashingtonUSA
  8. 8.Dana Farber Cancer InstituteBostonUSA
  9. 9.Department of Population SciencesBeckman Research Institute of City of HopeDuarteUSA
  10. 10.Yale UniversityNew HavenUSA
  11. 11.The Institute of Cancer Research & Royal Marsden NHS Foundation TrustLondonUK
  12. 12.The Institute of Cancer Research & Royal Marsden NHS Foundation TrustSuttonUK
  13. 13.Beth Israel Deaconess Medical CenterBostonUSA
  14. 14.City of Hope National Medical CenterDuarteUSA
  15. 15.Mayo Clinic College of MedicineRochesterUSA
  16. 16.NorthShore University HealthSystemEvanstonUSA
  17. 17.The University of ChicagoChicagoUSA
  18. 18.Jonsson Comprehensive Cancer Center at the University of CaliforniaLos AngelesUSA
  19. 19.Fox Chase Cancer CenterPhiladelphiaUSA
  20. 20.University of Chicago Medical CenterChicagoUSA
  21. 21.Southwestern Medical CenterUniversity of TexasDallasUSA
  22. 22.Baylor-Charles A. Sammons Cancer CenterDallasUSA

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