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Medline ® Abstract for Reference 25

of 'Management of patients at high risk for breast and ovarian cancer'

Impact of oophorectomy on cancer incidence and mortality in women with a BRCA1 or BRCA2 mutation.
Finch AP, Lubinski J, Møller P, Singer CF, Karlan B, Senter L, Rosen B, Maehle L, Ghadirian P, Cybulski C, Huzarski T, Eisen A, Foulkes WD, Kim-Sing C, Ainsworth P, Tung N, Lynch HT, Neuhausen S, Metcalfe KA, Thompson I, Murphy J, Sun P, Narod SA
J Clin Oncol. 2014;32(15):1547. Epub 2014 Feb 24.
PURPOSE: The purposes of this study were to estimate the reduction in risk of ovarian, fallopian tube, or peritoneal cancer in women with a BRCA1 or BRCA2 mutation after oophorectomy, by age of oophorectomy; to estimate the impact of prophylactic oophorectomy on all-cause mortality; and toestimate 5-year survival associated with clinically detected ovarian, occult, and peritoneal cancers diagnosed in the cohort.
PATIENTS AND METHODS: Women with a BRCA1 or BRCA2 mutation were identified from an international registry; 5,783 women completed a baseline questionnaire and≥one follow-up questionnaires. Women were observed until either diagnosis of ovarian, fallopian tube, or peritoneal cancer, death, or date of most recent follow-up. Hazard ratios (HRs) for cancer incidence and all-cause mortality associated with oophorectomy were evaluated using time-dependent survival analyses.
RESULTS: After an average follow-up period of 5.6 years, 186 women developed either ovarian (n = 132), fallopian (n = 22), or peritoneal (n = 32) cancer, of whom 68 have died. HR for ovarian, fallopian, or peritoneal cancer associated with bilateral oophorectomy was 0.20 (95% CI, 0.13 to 0.30; P<.001). Among women who had no history of cancer at baseline, HR for all-cause mortality to age 70 years associated with an oophorectomy was 0.23 (95% CI, 0.13 to 0.39; P<.001).
CONCLUSION: Preventive oophorectomy was associated with an 80% reduction in the risk of ovarian, fallopian tube, or peritoneal cancer in BRCA1 or BRCA2 carriers and a 77% reduction in all-cause mortality.
Amy P.M. Finch, Barry Rosen, Andrea Eisen, Kelly A. Metcalfe, Islay Thompson, Joan Murphy, Ping Sun, and Steven A. Narod, University of Toronto; Barry Rosen and Joan Murphy, Princess Margaret Hospital; Amy P.M. Finch, Islay Thompson, Ping Sun, and Steven A. Narod, Women's College Research Institute; Andrea Eisen, Sunnybrook Odette Cancer Center, Toronto; Peter Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, University of Montreal Hospital Centre; William D. Foulkes, McGill University, Montreal, Quebec; Charmaine Kim-Sing, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Jan Lubinski, Cezary Cybulski, and Tomasz Huzarski, Pomeranian Medical University, Szczecin, Poland; Pål Møller and Lovise Maehle, Norwegian Radium Hospital and Oslo University Hospital, Oslo, Norway; Christian F. Singer, Medical University of Vienna, Vienna, Austria; Beth Karlan, Cedars-Sinai Medical Center, Beverly Hills; Susan Neuhausen, City of Hope National Medical