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Risk reduction of contralateral breast cancer and survival after contralateral prophylactic mastectomy in BRCA1 or BRCA2 mutation carriers.

van Sprundel TC, Schmidt MK, Rookus MA, Brohet R, van Asperen CJ, Rutgers EJ, Van't Veer LJ, Tollenaar RA - Br. J. Cancer (2005)

Bottom Line: Contralateral prophylactic mastectomy reduced the risk of contralateral breast cancer by 91%, independent of the effect of bilateral prophylactic oophorectomy (BPO).After adjustment for BPO in a multivariate Cox analysis, the CPM effect on overall survival was no longer significant.The choice for CPM is highly correlated with that for BPO, while only BPO leads to a significant improvement in overall survival so far.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, D6-44, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.

ABSTRACT
The clinical outcome of contralateral prophylactic mastectomy (CPM) in women with a BRCA1 or BRCA2 mutation and a personal history of invasive breast cancer is unknown. We identified a cohort of 148 female BRCA1 or BRCA2 mutation carriers (115 and 33, respectively) who previously were treated for unilateral invasive breast cancer stages I-IIIa. In all, 79 women underwent a CPM, while the other women remained under intensive surveillance. The mean follow-up was 3.5 years and started at the time of CPM or at the date of mutation testing, whichever came last, that is, on average 5 years after diagnosis of the first breast cancer. One woman developed an invasive contralateral primary breast cancer after CPM, whereas six were observed in the surveillance group (P<0.001). Contralateral prophylactic mastectomy reduced the risk of contralateral breast cancer by 91%, independent of the effect of bilateral prophylactic oophorectomy (BPO). At 5 years follow-up, overall survival was 94% for the CPM group vs 77% for the surveillance group (P=0.03), but this was unexpectedly mostly due to higher mortality related with first breast cancer and ovarian cancer in the surveillance group. After adjustment for BPO in a multivariate Cox analysis, the CPM effect on overall survival was no longer significant. Our data show that CPM markedly reduces the risk of contralateral breast cancer among BRCA1 or BRCA2 mutation carriers with a history of breast cancer. Longer follow-up is needed to study the impact of CPM on contralateral breast cancer-specific survival. The choice for CPM is highly correlated with that for BPO, while only BPO leads to a significant improvement in overall survival so far.

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Related in: MedlinePlus

Contralateral breast cancer-free survival in patients who opted for CPM vs patients who remained under surveillance.
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fig1: Contralateral breast cancer-free survival in patients who opted for CPM vs patients who remained under surveillance.

Mentions: The contralateral breast cancer-free survival in the CPM group was significantly lower as compared to the women under surveillance (log rank, P=0.006) (Figure 1). Cox's proportional-hazards analysis showed that CPM significantly (P=0.028) decreased the risk of contralateral breast cancer (HR 0.09 (95% confidence interval (CI), 0.01–0.78)) (Table 4). Also within the group of women with a BPO, the risk of contralateral breast cancer was decreased after a CPM (3 vs 1 contralateral breast cancer in 39 women under surveillance and 61 women with CPM, respectively).


Risk reduction of contralateral breast cancer and survival after contralateral prophylactic mastectomy in BRCA1 or BRCA2 mutation carriers.

van Sprundel TC, Schmidt MK, Rookus MA, Brohet R, van Asperen CJ, Rutgers EJ, Van't Veer LJ, Tollenaar RA - Br. J. Cancer (2005)

Contralateral breast cancer-free survival in patients who opted for CPM vs patients who remained under surveillance.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2361560&req=5

fig1: Contralateral breast cancer-free survival in patients who opted for CPM vs patients who remained under surveillance.
Mentions: The contralateral breast cancer-free survival in the CPM group was significantly lower as compared to the women under surveillance (log rank, P=0.006) (Figure 1). Cox's proportional-hazards analysis showed that CPM significantly (P=0.028) decreased the risk of contralateral breast cancer (HR 0.09 (95% confidence interval (CI), 0.01–0.78)) (Table 4). Also within the group of women with a BPO, the risk of contralateral breast cancer was decreased after a CPM (3 vs 1 contralateral breast cancer in 39 women under surveillance and 61 women with CPM, respectively).

Bottom Line: Contralateral prophylactic mastectomy reduced the risk of contralateral breast cancer by 91%, independent of the effect of bilateral prophylactic oophorectomy (BPO).After adjustment for BPO in a multivariate Cox analysis, the CPM effect on overall survival was no longer significant.The choice for CPM is highly correlated with that for BPO, while only BPO leads to a significant improvement in overall survival so far.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, D6-44, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.

ABSTRACT
The clinical outcome of contralateral prophylactic mastectomy (CPM) in women with a BRCA1 or BRCA2 mutation and a personal history of invasive breast cancer is unknown. We identified a cohort of 148 female BRCA1 or BRCA2 mutation carriers (115 and 33, respectively) who previously were treated for unilateral invasive breast cancer stages I-IIIa. In all, 79 women underwent a CPM, while the other women remained under intensive surveillance. The mean follow-up was 3.5 years and started at the time of CPM or at the date of mutation testing, whichever came last, that is, on average 5 years after diagnosis of the first breast cancer. One woman developed an invasive contralateral primary breast cancer after CPM, whereas six were observed in the surveillance group (P<0.001). Contralateral prophylactic mastectomy reduced the risk of contralateral breast cancer by 91%, independent of the effect of bilateral prophylactic oophorectomy (BPO). At 5 years follow-up, overall survival was 94% for the CPM group vs 77% for the surveillance group (P=0.03), but this was unexpectedly mostly due to higher mortality related with first breast cancer and ovarian cancer in the surveillance group. After adjustment for BPO in a multivariate Cox analysis, the CPM effect on overall survival was no longer significant. Our data show that CPM markedly reduces the risk of contralateral breast cancer among BRCA1 or BRCA2 mutation carriers with a history of breast cancer. Longer follow-up is needed to study the impact of CPM on contralateral breast cancer-specific survival. The choice for CPM is highly correlated with that for BPO, while only BPO leads to a significant improvement in overall survival so far.

Show MeSH
Related in: MedlinePlus