• Eur. J. Cancer · Jun 2020

    Association of premenopausal risk-reducing salpingo-oophorectomy with breast cancer risk in BRCA1/2 mutation carriers: Maximising bias-reduction.

    • Neda Stjepanovic, Guillermo Villacampa, Kevin T Nead, Sara Torres-Esquius, Guadalupe G Melis, Katherine L Nathanson, Alexandre Teule, Joan Brunet, Teresa R Y Cajal, Gemma Llort, Rodrigo Dienstmann, Montserrat Rue, Susan M Domchek, and Judith Balmaña.
    • Vall d'Hebron University Hospital and Vall d'hebron Institute of Oncology (VHIO), Barcelona, Spain; Sunnybrook Health Sciences Centre, Toronto, Canada. Electronic address: neda.stjepanovic@sunnybrook.ca.
    • Eur. J. Cancer. 2020 Jun 1; 132: 53-60.

    BackgroundWhether 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.MethodsWe 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.ResultsDuring 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.ConclusionsPremenopausal 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.Copyright © 2020 Elsevier Ltd. All rights reserved.

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