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Survival after bilateral risk-reducing mastectomy in healthy BRCA1 and BRCA2 mutation carriers.
Heemskerk-Gerritsen, Bernadette A M; Jager, Agnes; Koppert, Linetta B; Obdeijn, A Inge-Marie; Collée, Margriet; Meijers-Heijboer, Hanne E J; Jenner, Denise J; Oldenburg, Hester S A; van Engelen, Klaartje; de Vries, Jakob; van Asperen, Christi J; Devilee, Peter; Blok, Marinus J; Kets, C Marleen; Ausems, Margreet G E M; Seynaeve, Caroline; Rookus, Matti A; Hooning, Maartje J.
Afiliação
  • Heemskerk-Gerritsen BAM; Department of Medical Oncology, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE, Rotterdam, The Netherlands. b.heemskerk-gerritsen@erasmusmc.nl.
  • Jager A; Department of Medical Oncology, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE, Rotterdam, The Netherlands.
  • Koppert LB; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
  • Obdeijn AI; Department of Radiology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
  • Collée M; Department of Clinical Genetics, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
  • Meijers-Heijboer HEJ; Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands.
  • Jenner DJ; Department of Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
  • Oldenburg HSA; Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.
  • van Engelen K; Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands.
  • de Vries J; Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
  • van Asperen CJ; Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
  • Devilee P; Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands.
  • Blok MJ; Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands.
  • Kets CM; Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.
  • Ausems MGEM; Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands.
  • Seynaeve C; Department of Medical Oncology, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE, Rotterdam, The Netherlands.
  • Rookus MA; Department of Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
  • Hooning MJ; Department of Medical Oncology, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE, Rotterdam, The Netherlands.
Breast Cancer Res Treat ; 177(3): 723-733, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31302855
ABSTRACT

BACKGROUND:

In healthy BRCA1/2 mutation carriers, bilateral risk-reducing mastectomy (BRRM) strongly reduces the risk of developing breast cancer (BC); however, no clear survival benefit of BRRM over BC surveillance has been reported yet.

METHODS:

In this Dutch multicenter cohort study, we used multivariable Cox models with BRRM as a time-dependent covariable to estimate the associations between BRRM and the overall and BC-specific mortality rates, separately for BRCA1 and BRCA2 mutation carriers.

RESULTS:

During a mean follow-up of 10.3 years, 722 out of 1712 BRCA1 (42%) and 406 out of 1145 BRCA2 (35%) mutation carriers underwent BRRM. For BRCA1 mutation carriers, we observed 52 deaths (20 from BC) in the surveillance group, and 10 deaths (one from BC) after BRRM. The hazard ratios were 0.40 (95% CI 0.20-0.90) for overall mortality and 0.06 (95% CI 0.01-0.46) for BC-specific mortality. BC-specific survival at age 65 was 93% for surveillance and 99.7% for BRRM. For BRCA2 mutation carriers, we observed 29 deaths (7 from BC) in the surveillance group, and 4 deaths (no BC) after BRRM. The hazard ratio for overall mortality was 0.45 (95% CI 0.15-1.36). BC-specific survival at age 65 was 98% for surveillance and 100% for BRRM.

CONCLUSION:

BRRM was associated with lower mortality than surveillance for BRCA1 mutation carriers, but for BRCA2 mutation carriers, BRRM may lead to similar BC-specific survival as surveillance. Our findings support a more individualized counseling based on BRCA mutation type.
Assuntos
Texto completo: Disponível Coleções: Bases de dados internacionais Contexto em Saúde: ODS3 - Saúde e Bem-Estar Tema em saúde: Meta 3.4: Reduzir as mortes prematuras devido doenças não transmissíveis Base de dados: MEDLINE Assunto principal: Neoplasias da Mama / Proteína BRCA1 / Proteína BRCA2 / Mastectomia Profilática / Heterozigoto / Mutação Limite: Feminino / Humanos País/Região como assunto: Europa Idioma: Inglês Revista: Breast Cancer Res Treat Ano de publicação: 2019 Tipo de documento: Artigo País de afiliação: Holanda

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Texto completo: Disponível Coleções: Bases de dados internacionais Contexto em Saúde: ODS3 - Saúde e Bem-Estar Tema em saúde: Meta 3.4: Reduzir as mortes prematuras devido doenças não transmissíveis Base de dados: MEDLINE Assunto principal: Neoplasias da Mama / Proteína BRCA1 / Proteína BRCA2 / Mastectomia Profilática / Heterozigoto / Mutação Limite: Feminino / Humanos País/Região como assunto: Europa Idioma: Inglês Revista: Breast Cancer Res Treat Ano de publicação: 2019 Tipo de documento: Artigo País de afiliação: Holanda