Preventive bilateral mastectomy (PBS) in BRCA mutation carriers with ovarian cancer: Is it justified?

Date 03 May 2019
Event ESMO Breast Cancer 2019
Session Poster lunch
Topics Breast Cancer
Hereditary Syndromes
Presenter Tamar Safra
Citation Annals of Oncology (2019) 30 (suppl_3): iii65-iii71. 10.1093/annonc/mdz101
Authors T. Safra1, B. Waissengrin1, D. Gerber2, R. Bernstein-Molcho3, R. Shaizaf1, J. Taff2, F. Mugia2, M. Frey2
  • 1Oncology, Tel Aviv Sourasky Medical Center-(Ichilov), 64239 - Tel Aviv/IL
  • 2Oncology, New York University (NYU) Cancer Institute, New York, New York/US
  • 3Oncology, Shiba Medical Center, Ramat Gan/IL

Abstract

Background

To determine the incidence of breast cancer (BC) in BRCA mutation carriers (BRCA+) after ovarian cancer (OC) diagnosis, and to re-evaluate BC surveillance in BRCA+ with OC.

Methods

A consecutive chart review, from 2000 to 2017, of OC patients at three medical centers: one in the USA and two in Israel. Clinical data collected included demographics, BRCA mutation types, timing of BC diagnosis (before or after OC diagnosis) and family history of cancer.

Results

Analysis revealed 284 BRCA+ with a median age at diagnosis of 55 years (range, 31.3-90) and median follow-up of 59.5 months (6-92); 209 patients were BRCA1 (73.5%) and 75 were BRCA2 (26.5%). The most common mutation was 185delAG (30.7%). Thirty-six patients (12.7%) were diagnosed with BC before OC. Fifty-four patients (20.5%) had a family history of BC and 187 (65%) were Ashkenazi Jews. Only 11 patients (3.89%) developed BC after OC diagnosis. Median time to BC after OC diagnosis was 109 months (29-93). There was a non-significant increase in BC after OC, and in BC prior to OC diagnosis, but there was no correlation of BC with family history.

Conclusions

The incidence of BC after OC diagnosis in the BRCA+ population was lower than expected. This finding may be attributed the high rate of OC mortality prior to BC development, OC chemotherapy treatment, or BC and OC clustering in families. Prophylactic bilateral mastectomy and/or MRI breast surveillance should be re-evaluated in this population and is possibly needed only in long survivors. Further investigation is warranted.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

Local IRB.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.