Effectiveness of Prophylactic Surgeries in BRCA1 or BRCA2 Mutation Carriers
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This was meta-analysis of 15 studies looked at clinical outcomes related to prophylactic mastectomy (PM) and bilateral salpingo-oophorectomy (PBSO) in women with BRCA1 and BRCA2 mutations. Bilateral PM significantly decreased breast cancer risk in both BRCA1 and BRCA2 mutation carriers (RR, 0.55 and 0.11, respectively), as did contralateral PM (RR, 0.072). PBSO and contralateral PM also reduced all-cause mortality in BRCA1/2 mutation carriers (HR, 0.35 and 0.51, respectively), while bilateral PM did not.
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The analysis found that prophylactic surgeries reduce incidence and mortality related to breast cancer.
abstract
This abstract is available on the publisher's site.
Access this abstract nowPURPOSE
To systematically investigate the effectiveness of prophylactic surgeries (PS) implemented in women carrying BRCA1/2 mutations.
EXPERIMENTAL DESIGN
The PubMed database was searched till August 2014 and 15 studies met the inclusion criteria. Fixed- or random-effects models were conducted according to study heterogeneity. We calculated the pooled relative risks (RRs) for cancer risk or mortality along with 95% confidence intervals (CIs).
RESULTS
Prophylactic bilateral salpingo-oophorectomy (PBSO) and bilateral prophylactic mastectomy (BPM) were both associated with a decreased BC risk in BRCA1/2 mutation carriers (RR = 0.552, 95% CI = 0.448-0.682; RR = 0.114, 95% CI = 0.041-0.317, respectively). Similar findings were observed in BRCA1 and BRCA2 mutation carriers separately. Moreover, contralateral prophylactic mastectomy (CPM) significantly decreased contralateral BC incidence in BRCA1/2 mutation carriers (RR = 0.072, 95% CI = 0.035-0.148). Of note, PBSO was associated with significantly lower all-cause mortality in BRCA1/2 mutation carriers without BC (HR = 0.349, 95% CI = 0.190-0.639) and those with BC (HR = 0.432, 95% CI = 0.318-0.588). In addition, all-cause mortality was significantly lower for patients with CPM than those without (HR = 0.512, 95% CI = 0.368-0.714). However, BPM was not significantly associated with reduced all-cause mortality. Data were insufficient to obtain separate estimates of survival benefit with PS in BRCA1 or BRCA2 mutation carriers.
CONCLUSIONS
BRCA1/2 mutation carriers who have been treated with PS have a substantially reduced BC incidence and mortality.
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Additional Info
Effectiveness of Prophylactic Surgeries in BRCA1 or BRCA2 Mutation Carriers: A Meta-Analysis and Systematic Review
Clin. Cancer Res 2016 Mar 15;[EPub Ahead of Print], X Li, R You, X Wang, C Liu, Z Xu, J Zhou, B Yu, T Xu, H Cai, Q ZouFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.