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Oophorectomy Curbs Ovarian And Breast Cancer Risks In Carriers of BRCA Mutations

Bilateral prophylactic oophorectomy reduces risk of coelomic epithelial cancer and breast cancer in women with BRCA1 or BRCA2 mutations.

This has now been confirmed by two large and complementary studies, validating the current practice of recommending preventive oophorectomy in post-childbearing women carrying a mutant BRCA gene and providing a strong rationale for genetic testing in women with a strong family history of breast cancer.

Until now, data on the efficacy of bilateral prophylactic oophorectomy for reducing risk of gynaecologic cancer in women with these mutations have been limited.

The first of these two studies was a multicentre international investigation for the Prevention and Observation of Surgical End Points Study Group led by researchers at University of Pennsylvania School of Medicine, Philadelphia, United States.

This group retrospectively investigated 551 women with disease-associated germ-line BRCA1 or BRCA2 mutations for occurrence of ovarian and breast cancer.

Among 292 women who had not undergone prophylactic oophorectomy, ovarian cancer developed in 58 (19.9 percent) during a mean follow-up of nearly nine years.

In contrast to this, among 259 women who did undergo the procedure, a stage I ovarian tumour was identified at surgery in six (2.3 percent), and primary peritoneal cancer subsequently developed in two others (0.8 percent).

In a subgroup analysis of 241 women with no history of breast cancer or prophylactic mastectomy, the investigators looked at the incidence of breast cancer in 99 women who underwent bilateral prophylactic oophorectomy and in 142 matched controls who did not. They found that breast cancer was diagnosed in 60 (42.3 percent) of the 142 women who were followed conservatively, versus 21 (21.2 percent) of the 99 women who had undergone prophylactic oophorectomy.

Noah D. Kauff and colleagues from Memorial Sloan Kettering Cancer Center, New York, New York, carried out the second of these studies, a prospective investigation of 170 carriers of these two mutations.

This team sought to compare the effect of risk-reducing salpingo-oophorectomy with that of surveillance for ovarian cancer on the incidence of subsequent breast cancer and BRCA-related gynaecologic cancers in these women.

In a mean follow-up of two years, breast cancer was diagnosed in three of the 98 women who chose risk-reducing salpingo-oophorectomy, and peritoneal cancer was diagnosed in one of them.

Among the 72 women who chose surveillance, breast cancer was diagnosed in eight, ovarian cancer in four and peritoneal cancer in one. Time to breast cancer or BRCA-related gynaecologic cancer was longer in the salpingo-oophorectomy group.

This procedure in carriers of BRCA mutations can thus decrease risk of breast cancer and BRCA-related gynaecologic cancer, conclude these authors.

Both of these studies were published online May 20 in advance of their formal publication on May 23, 2002, to coincide with their presentation at a meeting of the American Society for Clinical Oncology.
N Engl J Med 2002;346:1616-22. N Engl J Med 2002;346:1609-15.

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