Breast Cancer Risk After Salpingo-Oophorectomy in Healthy BRCA1/2 Mutation Carriers: Revisiting the Evidence for Risk Reduction

Abstract

In previous studies, BC risk reduction after RRSO in BRCA1/2 mutation carriers may have been overestimated because of bias. Using a design that maximally eliminated bias, we found no evidence for a protective effect.

Risk reducing salpingectomy and delayed oophorectomy in high risk women: views of cancer geneticists, genetic counsellors and gynaecological oncologists in the UK

“…[20][21][22] Compared to geneticists, gynaecologists were half as aware of the 50% reduction in breast cancer risk with premenopausal RRSO. While a number of analyses in the high-risk [19,36] women have shown this benefit, a recent Dutch paper published after this survey [37] underlined methodological deficiencies in earlier analyses [36,38,39] and reported no benefit of breast cancer risk reduction from premenopausal RRSO. However, a key limitation was the short follow-up of only 3.2 years.…”

RAZOR: A Phase II Open Randomized Trial of Screening Plus Goserelin and Raloxifene Versus Screening Alone in Premenopausal Women at Increased Risk of Breast Cancer

“…Furthermore, the magnitude of any reduction in breast cancer risk following bilateral oophorectomy in BRCA1 mutation carriers has recently been questioned (6,7). The poor adherence is due not only to vasomotor side effects but also to the perceived need for surgical prophylaxis in this group of women at particularly high risk.…”

“…Observational studies of women who undergo premenopausal bilateral oophorectomy, both in the general population and in the majority of studies in those with inactivating mutations in the BRCA1 and BRCA2 genes, have a reduction in breast cancer risk of as much as 50% with a greater effect the younger the age of operation (1,2,3,4,5,6,7).…”

Análise de custo-efetividade de programa para diagnóstico de mutação germinativa em genes BRCA1/2 e de estratégias preventivas para pacientes com câncer de ovário e seus familiares de primeiro grau

“…Estudos prospectivos que apresentam risco relativo para câncer de mama após a realização de mastectomia bilateral profilática (45,(131)(132)(133) . (17,43,44,131,(134)(135)(136) .…”

“…Tal estudo revisou análises anteriores e concluiu que o efeito profilático poderia estar superestimado em decorrência de imprecisões. Assim, por meio do uso de metodologia para maximizar a eliminação de vieses, os autores informaram não encontrar evidências do efeito protetor previamente descrito (risco relativo: 1,09; intervalo de confiança de 95%: 0,67-1,77) (136) . apresentar mutação germinativa (95,98,99,102) .…”