Risk reducing mastectomy: outcomes in 10 European centres

The hereditary breast and ovarian cancer (HBOC) registration system of Japan was established by the Japanese HBOC Consortium. The first trial was registered in 2015 in four institutions to which some registration committee members belonged. We analyzed the information of 830 Japanese pedigrees, who underwent BRCA1/2 genetic testing, including mutation carriers with BRCA1 (N = 127) and BRCA2 (N = 115), and their families. The mutation-positive rate was 19.7%. Variants of uncertain significance were found in 6.5% of all individuals subjected to genetic testing for BRCA1/2. Compared to the United States, Japan had a higher mutation-positive rate in most categories, except for the groups with male breast cancer. Among the intrinsic subtypes of BRCA1-associated breast cancers, 75.8% were triple-negative. The incidence rate of contralateral breast cancer in BRCA1/2 mutation carriers was 0.99%/year. Among 240 mutation carriers, 26 and 62 patients underwent risk-reducing mastectomy (RRM) and risk-reducing salpingo-oophorectomy (RRSO), respectively; the respective frequencies of occult cancer were 7.1 and 3.2%. Metachronous breast cancer after RRM or peritoneal cancer after RRSO was not observed during the follow-up period. The nationwide registration system began last year and the system enables followup analysis in Japan.

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“…However, the sample size was small. Therefore, further studies are required to confirm these numbers [24,25].…”

Section: Discussionmentioning

confidence: 99%

Genetic and clinical characteristics in Japanese hereditary breast and ovarian cancer: first report after establishment of HBOC registration system in Japan

et al. 2017

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“…They are advised that undertaking this procedure before 50 y of age will also reduce their risk of breast cancer and that this risk reduction is not substantially abrogated by taking hormone replacement therapy (6).…”

Section: Methodsmentioning

confidence: 99%

“…Many women with BRCA1 or BRCA2 mutations now seriously consider undergoing bilateral risk-reducing mastectomy (BRRM) and/or bilateral risk-reducing salpingo-oophorectomy (BRRSPO). The efficacy of surgical procedures for reducing the risk of breast and ovarian cancer is now beyond dispute (2)(3)(4)(5)(6). However, uptake rates vary enormously with a much lower uptake in Israel and southern Europe compared with northern Europe (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Uptake of Risk-Reducing Surgery in Unaffected Women at High Risk of Breast and Ovarian Cancer Is Risk, Age, and Time Dependent

Evans

Lalloo

Ashcroft

et al. 2009

Cancer Epidemiology, Biomarkers &Amp; Prevention

133

107

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Purpose: The uptake of risk-reducing surgery in women at increased risk of breast and ovarian cancer is highly variable between countries and centers within countries. We have investigated the rate, timing, and age of uptake of surgery in the northwest of England to report the results after up to 7 years in a Regional Genetics center. Methods: Uptake was documented in 211 known unaffected BRCA1/2 mutation carriers from 509 families and in 3,515 women at >25% lifetime risk of breast cancer without known mutations. Results: Of the 211 mutation carriers, 40% opted for bilateral risk-reducing mastectomy (BRRM) and 45% underwent bilateral risk-reducing salpingo-oophorectomy (BRRSPO). Uptake of BRRM was significantly related to lifetime risk and age but continued over several years. In women not known to carry a BRCA mutation, 6.4% of women at 40% to 45% lifetime risk, 2.5% of women at 33% to 39% lifetime risk, and 1.8% of women at 25% to 32% lifetime risk underwent BRRM (P < 0.005). BRRSPO uptake was greater in BRCA1 (52%) than BRCA2 (28%) carriers but in both groups tended to occur within the first 2 years after gene test (except in the youngest age group) and in women between the ages of 35 and 45. Conclusion: To truly assess the uptake of risk-reducing surgery, longer-term follow-up is necessary particularly in younger women who are likely to delay BRRSPO. Careful risk counseling does seem to influence women's decisions for surgery, although the effect is not immediate. (Cancer Epidemiol Biomarkers Prev 2009;18(8): 2318-24)

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“…While ovarian screening in high-risk groups is not effective, breast cancer screening is indicated and there is evidence of increased sensitivity of magnetic resonance imaging (MRI) for detecting malignancies in younger BRCA carriers [8,9], compared to mammography. Risk-reducing mastectomy (RRM) and/or oophorectomy (RRSO) results in a significant decrease in mortality in high-risk women [6,7,10,11]. Domcheck et al [11] found that RRSO was associated with lower all-cause mortality, as well as lower breast cancerspecific and ovarian cancer-specific mortality.…”

Section: Introductionmentioning

confidence: 99%

Looking different, feeling different: women’s reactions to risk-reducing breast and ovarian surgery

et al. 2011

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Objectives Most studies of quality of life following risk-reducing bilateral salpingo -oophorectomy (RRSO) and mastectomy (RRM) for inherited breast and ovarian cancer susceptibility were conducted before counseling protocols were established and included women at varying times since surgery. This study aimed to overcome these deficiencies and to provide current data on outcomes for this growing group of women.Methods Semi-structured interviews were used to explore the experiences of an Australian cohort of 40 high-risk women three years after they underwent RRM and/or RRSO. Data were analyzed using the method of constant comparison.Results Nineteen women underwent RRSO, 8 RRM and 13 both procedures. Two themes -looking different and feeling different -captured the psychosocial impact of surgery upon interviewees. All were relieved at having the risk of cancer substantially reduced that had previously been embodied in their breasts and ovaries; however, reducing risk by removing these body parts is not without costs. Interviewees reported experiencing a range of negative emotions and a range of unexpected bodily sensations following surgery and reflected upon both positive and negative changes in their appearance. Women said they had been unprepared for the lack of sensation in reconstructed breasts and/or the severity of menopausal symptoms, which often had a negative impact upon sexuality. ConclusionsAlthough women who undergo RR surgery are informed about its sequelae, however, few are entirely prepared for the reality of undergoing this procedure. We recommend that women who undergo these procedures should be provided with psychosocial support before and after RR surgery.

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Risk reducing mastectomy: outcomes in 10 European centres

Abstract: We conclude that risk reducing surgery is highly effective.

Cited by 76 publications

References 28 publications

Genetic and clinical characteristics in Japanese hereditary breast and ovarian cancer: first report after establishment of HBOC registration system in Japan

Genetic and clinical characteristics in Japanese hereditary breast and ovarian cancer: first report after establishment of HBOC registration system in Japan

Uptake of Risk-Reducing Surgery in Unaffected Women at High Risk of Breast and Ovarian Cancer Is Risk, Age, and Time Dependent

Looking different, feeling different: women’s reactions to risk-reducing breast and ovarian surgery

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