Risk of breast cancer after a diagnosis of ovarian cancer in BRCA mutation carriers: Is preventive mastectomy warranted?
Risk of breast cancer after a diagnosis of ovarian cancer in BRCA mutation carriers: Is preventive mastectomy warranted?
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DOI：
10.1016/j.ygyno.2017.02.032
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发表时间：
2017-05-01
影响因子：
4.7
通讯作者：
Narod, Steven A.
中科院分区：
文献类型：
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作者：
Mcgee, Jacob;Giannakeas, Vasily;Narod, Steven A.
Objective.为未受影响的BRCA突变携带者提供预防性乳房手术和MRI筛查。这两种方式的临床益处尚未在有卵巢癌病史的突变携带者中进行评估。因此，我们试图确定是否BRCA突变携带者卵巢癌将受益于预防性乳房切除术或MRI筛查。首先，对来自加拿大安大略的178名BRCA突变携带者队列中卵巢癌患者的年死亡率进行了估计。接下来，使用509例BRCA突变携带者卵巢癌的国际注册来估计发生乳腺癌的精算风险。进行了一系列模拟，以评估与乳房切除术和基于MRI的乳房监测相关的死亡概率（所有原因）的降低。采用考克斯比例风险模型评估乳腺切除术和MRI筛查对乳腺癌发病率和全因死亡率的影响。509例患者中有20例（3.9%）在卵巢癌诊断后10年内发生乳腺癌。诊断后10年患乳腺癌的精算风险为7.8%，条件是卵巢癌和其他死亡原因的生存率。根据我们的模拟结果，在50岁时诊断为III/IV期卵巢癌的所有携带BRCA突变的患者中，MRI使80岁之前死亡的几率降低了不到1%，乳房切除术降低了不到2%。对于卵巢癌后已经存活10年的女性，以及I期或II期卵巢癌的女性，观察到MRI或乳房切除术的生存率有更大的改善。
Objective. Preventive breast surgery and MRI screening are offered to unaffected BRCA mutation carriers. The clinical benefit of these two modalities has not been evaluated among mutation carriers with a history of ovarian cancer. Thus, we sought to determine whether or not BRCA mutation carriers with ovarian cancer would benefit from preventive mastectomy or from MRI screening.Methods. First, the annual mortality rate for ovarian cancer patients was estimated for a cohort of 178 BRCA mutation carriers from Ontario, Canada. Next, the actuarial risk of developing breast cancer was estimated using an international registry of 509 BRCA mutation carriers with ovarian cancer. A series of simulations was conducted to evaluate the reduction in the probability of death (from all causes) associated with mastectomy and with MRI-based breast surveillance. Cox proportional hazards models were used to evaluate the impacts of mastectomy and MRI screening on breast cancer incidence as well as on all-cause mortality.Results. Twenty (3.9%) of the 509 patients developed breast cancer within ten years following ovarian cancer diagnosis. The actuarial risk of developing breast cancer at ten years post-diagnosis, conditional on survival from ovarian cancer and other causes of mortality was 7.8%. Based on our simulation results, among all BRCA mutation carrying patients diagnosed with stage III/IV ovarian cancer at age 50, the chance of dying before age 80 was reduced by less than 1% with MRI and by less than 2% with mastectomy. Greater improvements in survival with MRI or mastectomy were observed for women who had already survived 10 years after ovarian cancer, and for women with stage I or II ovarian cancer.