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Previous Volume 346:1609-1615 May 23, 2002 Number 21 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Haber, D. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Risk-reducing salpingo-oophorectomy is often considered by carriers of BRCA mutations who have completed childbearing. However, there are limited data supporting the efficacy of this approach. We prospectively compared the effect of risk-reducing salpingo-oophorectomy with that of surveillance for ovarian cancer on the incidence of subsequent breast cancer and BRCA-related gynecologic cancers in women with BRCA mutations.

Methods All women with BRCA1 or BRCA2 mutations identified during a six-year period were offered enrollment in a prospective follow-up study. A total of 170 women 35 years of age or older who had not undergone bilateral oophorectomy chose to undergo either surveillance 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 two groups was compared by Kaplan–Meier analysis and a Cox proportional-hazards model.

Results During a mean follow-up of 24.2 months, breast cancer was diagnosed in 3 of the 98 women who chose risk-reducing salpingo-oophorectomy and peritoneal cancer was diagnosed in 1 woman in this group. Among the 72 women who chose surveillance, breast cancer was diagnosed in 8, ovarian cancer in 4, and peritoneal cancer in 1. The time to breast cancer or BRCA-related gynecologic cancer was longer in the salpingo-oophorectomy group, with a hazard ratio for subsequent breast cancer or BRCA-related gynecologic cancer of 0.25 (95 percent confidence interval, 0.08 to 0.74).

Conclusions Salpingo-oophorectomy in carriers of BRCA mutations can decrease the risk of breast cancer and BRCA-related gynecologic cancer.

Source Information

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.

Full Text of this Article

Related Letters:

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. Correspondence

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