Risk-Reducing Salpingo-oophorectomy in Women with a BRCA1 or BRCA2 Mutation
Noah D. Kauff, M.D., Jaya M. Satagopan, Ph.D., Mark E. Robson, M.D., Lauren Scheuer, M.S., Martee Hensley, M.D., Clifford A. Hudis, M.D., Nathan A. Ellis, Ph.D., Jeff Boyd, Ph.D., Patrick I. Borgen, M.D., Richard R. Barakat, M.D., Larry Norton, M.D., Mercedes Castiel, M.D., Khedoudja Nafa, Ph.D., and Kenneth Offit, M.D., M.P.H.
Background Risk-reducing salpingo-oophorectomy is often consideredby carriers of BRCA mutations who have completed childbearing.However, there are limited data supporting the efficacy of thisapproach. We prospectively compared the effect of risk-reducingsalpingo-oophorectomy with that of surveillance for ovariancancer on the incidence of subsequent breast cancer and BRCA-relatedgynecologic cancers in women with BRCA mutations.
Methods All women with BRCA1 or BRCA2 mutations identified duringa six-year period were offered enrollment in a prospective follow-upstudy. A total of 170 women 35 years of age or older who hadnot undergone bilateral oophorectomy chose to undergo eithersurveillance for ovarian cancer or risk-reducing salpingo-oophorectomy.Follow-up involved an annual questionnaire, telephone contact,and reviews of medical records. The time to cancer in the twogroups was compared by Kaplan–Meier analysis and a Coxproportional-hazards model.
Results During a mean follow-up of 24.2 months, breast cancerwas diagnosed in 3 of the 98 women who chose risk-reducing salpingo-oophorectomyand peritoneal cancer was diagnosed in 1 woman in this group.Among the 72 women who chose surveillance, breast cancer wasdiagnosed in 8, ovarian cancer in 4, and peritoneal cancer in1. The time to breast cancer or BRCA-related gynecologic cancerwas longer in the salpingo-oophorectomy group, with a hazardratio for subsequent breast cancer or BRCA-related gynecologiccancer of 0.25 (95 percent confidence interval, 0.08 to 0.74).
From the Clinical Genetics Service (N.D.K., M.E.R., L.S., N.A.E., J.B., K.O.), the Breast Cancer Medicine Service (M.E.R., C.A.H., L.N.), and the Developmental Chemotherapy Service (M.H.), Department of Medicine; the Department of Epidemiology and Biostatistics (J.M.S.); and the Gynecology Service (J.B., R.R.B.) and the Breast Service (P.I.B.), Department of Surgery — all at Memorial Sloan-Kettering Cancer Center, New York. Other authors were Mercedes Castiel, M.D. (Gynecology Service, Department of Surgery), and Khedoudja Nafa, Ph.D. (Clinical Genetics Service, Department of Medicine), Memorial Sloan-Kettering Cancer Center, New York.
Address reprint requests to Dr. Offit at the Clinical Genetics Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, or at offitk{at}mskcc.org.
Oophorectomy in Carriers of BRCA Mutations
Zhuang S. H., Leonard G. D., Swain S. M., Peshkin B. N., DeMarco T. A., Schwartz M. D., Anderson W. F., Brawley O. W., Chang S., Whitfield G. A., Kauff N. D., Robson M. E., Offit K., Rebbeck T. R., Weber B. L.
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N Engl J Med 2002;
347:1037-1040, Sep 26, 2002.
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