NATIONAL CANCER INSTITUTE
For Women with BRCA Mutations, Prophylactic Surgery Reduces Cancer Risk
Adapted from the NCI Cancer Bulletin, vol. 7/no. 17, September 7, 2010
Prophylactic surgery to remove the breasts and ovaries is an effective way to reduce the risk of breast and ovarian cancer among women with inherited mutations in the BRCA1 or BRCA2 genes, according to one of the largest prospective studies on the subject to date. The findings, published September 1, 2010, in JAMA, provide estimates of the benefits of mastectomy and salpingo-oophorectomy (removal of the ovaries and fallopian tubes) in reducing the risk of cancer and death among carriers of disease-associated BRCA1 or BRCA2 gene mutations. These mutations confer a 56 to 84 percent lifetime risk of breast cancer.
The results also show that the risk reduction occurs regardless of whether the mutation is located in the BRCA1 or BRCA2 gene or whether a woman had cancer previously. Researchers at 22 medical centers in Europe and North America tracked nearly 2,500 women with a disease-associated BRCA1 or BRCA2 mutation. Almost half of the women had one of the prophylactic surgeries.
During 3 years of follow-up, none of the women who had a mastectomy developed breast cancer, while 7 percent of the women who didn’t have the surgery were diagnosed with breast cancer. And only 1 percent of the women who underwent risk-reducing salpingo-oophorectomy developed ovarian cancer during 6 years of follow-up, compared with 6 percent of women who did not have the surgery.
“This study reinforces the message that genetic testing has value,” said Timothy Rebbeck, Ph.D., of the University of Pennsylvania, the study’s senior author. Women who know that they have inherited a high-risk mutation can, with the appropriate genetic counseling, take steps to reduce their risk of cancer through prophylactic surgery, he continued.
Although many women choose prophylactic surgery, many do not, the study authors noted. Just 10 percent of the women in the study chose prophylactic mastectomy and 38 percent chose salpingo-oophorectomy. “For women who have these genetic mutations, we think we can save lives,” Dr. Rebbeck stressed. “And that’s an important message.”
The authors of an accompanying editorial in JAMA echoed this message and noted that options for prophylactic surgeries have changed and improved. For example, laparoscopic salpingo-oophorectomy is a relatively low-risk procedure that can be done in an outpatient setting, while new techniques for mastectomy produce a more natural appearance, wrote Laura Esserman, M.D., of the University of California, San Francisco, and Virginia Kaklamani, M.D., of Northwestern University.
http://www.cancer.gov/clinicaltrials/results/prophylactic-surgery0910
Surgical Decision-making in Early-stage Breast Cancer
Journal of the National Cancer Institute, 15 September 2009
Patients with early-stage breast cancer who take an active role in decision-making tend to opt for mastectomy over lumpectomy, despite the fact that the procedures have been shown to produce equivalent outcomes, according to the results of a study published in the Journal of the National Cancer Institute.[1]
Women with early-stage breast cancer may be treated with mastectomy (removal of the entire breast) or breast-conserving therapy (which involves lumpectomy, or removal of the cancer and a portion of surrounding tissue, plus radiation). Mastectomy and breast-conserving therapy have been shown to produce similar long-term survival outcomes in women with early-stage breast cancer.[2] Because these treatment approaches produce similar outcomes, many professionals have endorsed breast-conserving therapy as the preferred treatment strategy; however, many women with early-stage breast cancer continue to undergo mastectomy.
Using the Surveillance, Epidemiology, and End Results (SEER) registries from Los Angeles and Detroit, researchers evaluated a group of women diagnosed with early-stage breast cancer between 2005 and 2007. The study included 1,651 women with carcinoma in situ, Stage I or Stage II breast cancer. The study group was racially diverse, with 23.9% Latina, 27.1% African-American, and 48.9% White women. The women responded to questionnaires regarding their role in decision-making, attitudes about recurrence, the impact of surgery on body image, and the role of others in their decision-making.
Overall, 17.2% of the women underwent mastectomy initially. The researchers found that more women who reported a “patient-based decision” underwent mastectomy compared with those who reported a “shared or surgeon-based decision.” Women who reported that they were concerned about recurrence or the effects of radiation were more likely to choose mastectomy than those who did not share those concerns. In contrast, women who reported concerns about body image or their spouse’s opinion were more likely to opt for breast-conserving therapy than women who were less concerned about body image or who were less influenced by their spouses’ opinion.
The researchers concluded that patients’ attitudes and perceptions play a powerful role in their treatment decisions. A higher level of patient involvement in decision-making was associated with a higher rate of mastectomy, regardless of race or ethnicity.
Reference:
[1] Hawley ST, Griggs JJ, Hamilton AS, et al. Decision involvement and receipt of mastectomy among racially and ethnically diverse breast cancer patients. Journal of the National Cancer Institute. 2009; 101: 1-11.
[2] Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. The New England Journal of Medicine. 2002;347;1227-1232.