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Preventive oophorectomy in BRCA mutation carriers reduced cancer risk by 80%
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BRCA1 or BRCA2 mutation carriers who underwent oophorectomy demonstrated an 80% reduced risk for ovarian, fallopian tube or peritoneal cancers, and a 77% reduced risk for all-cause mortality, according to study results.
Steven Narod, MD, professor of medicine at the University of Toronto, and colleagues used an international registry to identify 5,783 women who harbored a BRCA1 or BRCA2 mutation. All participants completed questionnaires at baseline and at least once during follow-up.
During a median follow-up of 5.6 years, there were 186 new incidences of ovarian, fallopian tube or peritoneal cancers, which resulted in 68 deaths. Of the 186 cases, 108 (58%) occurred in women who had not undergone oophorectomy (BRCA1, n=98; BRCA2, n=10).
The highest annual cancer risk for BRCA1 carriers occurred from age 50 to 59 years (1.7%), whereas the highest annual risk for BRCA2 carriers occurred from age 60 to 69 years (0.6%).
The incidence of occult carcinomas was 1.5% among women harboring BRCA1 mutations who underwent oophorectomy when younger than 40 years. The incidence increased to 3.8% among women who underwent oophorectomy from age 40 to 49 years.
Researchers estimated a 4% risk for ovarian cancer associated with delaying surgery among BRCA1 mutation carriers until age 40 years, and a 14.2% risk when delaying surgery until age 50 years.
Overall, bilateral oophorectomy was associated with an 80% reduction in the risk for ovarian, fallopian or peritoneal cancers (HR=0.2; 95% CI, 0.13-0.3).
Researchers then estimated oophorectomy’s effect on mortality up to age 70 years. They calculated a 0.23 HR (95% CI, 0.13-0.39) for all-cause mortality among women without a history of cancer at baseline.
“These data are so striking that we believe prophylactic oophorectomy by age 35 should become a universal standard for women with BRCA1 mutations,” Narod said in a press release. “Women with BRCA2 mutations, on the other hand, can safely delay surgery until their 40s, since their ovarian cancer risk is not as strong.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Don Dizon, MD
These results could make a real difference for women with BRCA mutations, who face tough decisions about whether and when to undergo a prophylactic oophorectomy. For women with BRCA1 mutations, these results suggest that surgery should be performed as soon as it is practical. Importantly, for women who will be undergoing this surgery early in life, it’s reassuring to see that it carries long-lasting benefits, substantially reducing ovarian cancer risk as well as total mortality risk.
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