Association of premenopausal risk-reducing salpingo-oophorectomy with breast cancer risk in BRCA1/2 mutation carriers: Maximising bias-reduction
Por:
Stjepanovic, N, Villacampa, G, Nead, KT, Torres-Esquius, S, Melis, GG, Nathanson, KL, Teule, A, Brunet, J, Cajal, TRY, Llort, G, Dienstmann, R, Rue, M, Domchek, SM, Balmana, J
Publicada:
1 jun 2020
Resumen:
Background: Whether risk-reducing salpingo-oophorectomy (RRSO) in BRCA1/2 carriers reduces the breast cancer (BC) risk is conflicting, potentially due to methodological issues of prior analysis. We analysed the association between premenopausal RRSO and BC risk in BRCA1/2 carriers after adjusting for potential biases.
Methods: We analysed data from 444 BRCA1 and 409 BRCA2 carriers under age 51 with no cancer prior to genetic testing or during first 6 months of surveillance (to avoid cancer-induced testing bias and prevalent-cancer bias). Observation started 6 months after genetic testing (to avoid event-free time bias), until BC diagnosis, risk-reducing mastectomy (RRM) or death. A multistate model with four states (non-RRSO, RRSO, RRM and BC) and five transitions was fitted to characterise outcomes and to calculate the BC risk reduction after premenopausal RRSO (before age 51). A systematic review was performed to assess the association between premenopausal RRSO and BC.
Results: During a mean follow-up of 4.3 years, 96 women (11.3%) developed BC (54 BRCA1, 42 BRCA2). The risk of BC after premenopausal RRSO decreased significantly in BRCA1 carriers (hazard ratio (HR) = 0.45 [95% confidence interval (CI):0.22-0.92]), but was not conclusive in BRCA2 carriers (HR = 0.77 [95%CI:0.35-1.67]). The systematic review suggested that premenopausal RRSO is associated with a decrease of BC risk in both BRCA1 and BRCA2 carriers.
Conclusions: Premenopausal RRSO was associated with BC risk reduction in BRCA1 carriers, which can help guide cancer risk-reducing strategies in this population. Longer follow-up and larger sample size may be needed to estimate the potential benefit in BRCA2 carriers. (C) 2020 Elsevier Ltd. All rights reserved.
Filiaciones:
Stjepanovic, N:
Vail dHebron Univ Hosp, Barcelona, Spain
Vall dHebron Inst Oncol VHIO, Barcelona, Spain
Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada
Villacampa, G:
Vail dHebron Univ Hosp, Barcelona, Spain
Vall dHebron Inst Oncol VHIO, Barcelona, Spain
Nead, KT:
Univ Penn, Basser Ctr BRCA, Philadelphia, PA 19104 USA
Univ Penn, Abramson Canc Ctr, Philadelphia, PA 19104 USA
Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA
Anderson Canc Ctr, Houston, TX USA
Torres-Esquius, S:
Vail dHebron Univ Hosp, Barcelona, Spain
Vall dHebron Inst Oncol VHIO, Barcelona, Spain
Melis, GG:
Univ Politecn Cataluna, Barcelona, Spain
Nathanson, KL:
Univ Penn, Basser Ctr BRCA, Philadelphia, PA 19104 USA
Univ Penn, Abramson Canc Ctr, Philadelphia, PA 19104 USA
Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA
Teule, A:
IDIBELL, Catalan Inst Oncol, Barcelona, Spain
Brunet, J:
IDIBELL, Catalan Inst Oncol, Barcelona, Spain
IDIBGI, Catalan Inst Oncol, Girona, Spain
Cajal, TRY:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Llort, G:
Hosp Univ, Parc Tauli Sabadell, Barcelona, Spain
Dienstmann, R:
Vail dHebron Univ Hosp, Barcelona, Spain
Vall dHebron Inst Oncol VHIO, Barcelona, Spain
Rue, M:
Univ Lleida, Lleida Biomed Res Inst UdL IRBLleida, Lleida, Spain
Domchek, SM:
Univ Penn, Basser Ctr BRCA, Philadelphia, PA 19104 USA
Univ Penn, Abramson Canc Ctr, Philadelphia, PA 19104 USA
Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA
Balmana, J:
Vail dHebron Univ Hosp, Barcelona, Spain
Vall dHebron Inst Oncol VHIO, Barcelona, Spain
Green Published
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