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Low Risk of Breast Cancer After Ovarian Cancer in Women With BRCA Mutation

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Key Points

  • Breast cancer occurred in 8.9% of BRCA mutation carriers.
  • Breast cancer was early stage in all patients and was diagnosed by mammography in 7 of 12.

In a retrospective single-institution study reported in JAMA Surgery, Gangi et al found a low risk of breast cancer after diagnosis of ovarian cancer in women harboring BRCA mutations.  

The study involved 364 women who had BRCA mutation testing for stage I to IV epithelial ovarian cancer between 1998 and 2012 at Cedars-Sinai Medical Center, Los Angeles. A germline BRCA1 or BRCA2 mutation was found in 135 (37.1%). The mean age of these patients at the time of ovarian cancer diagnosis was 51.9 years.

Rate of Breast Cancer

Of the 135 patients with BRCA mutation, 12 (8.9%) developed breast cancer. The median time from diagnosis of ovarian cancer to breast cancer was 50.5 months. Annual mammography was performed in 80 patients (59.3%), and annual breast magnetic resonance imaging was performed in 60 (44.4%). Bilateral prophylactic mastectomy was performed in 13 patients (9.6%) at a median of 23 months after ovarian cancer diagnosis.

Diagnosis

Breast cancer in the 12 women was diagnosed by mammography in 7 (58.3%), of whom 3 had a palpable mass and 2 had incidental breast cancer detected during prophylactic mastectomy. All had stage 0 to II disease.  Seven (58.3%) underwent bilateral mastectomy, and four (33.3%) received adjuvant chemotherapy. At median follow-up of 6.3 years, 4 (33.3%) of the 12 patients had died of recurrent ovarian cancer after the diagnosis of breast cancer. The 10-year overall survival rate for the entire cohort of 135 patients was 17.0%.

The investigators concluded: “The risk of metachronous breast cancer is low in patients with known BRCA mutations and [epithelial ovarian cancer]. A majority of these cases of breast cancer at an early stage are detected by use of mammography. Despite the small number of patients in our study, these results suggest that optimal breast cancer surveillance for patients with BRCA-associated [epithelial ovarian cancer] needs to be reevaluated given the low incidence of breast cancer among these high-risk patients. Confirmation of our findings from larger studies seems to be indicated.”

Farin Amersi, MD, of Cedars-Sinai Medical Center, Los Angeles, is the corresponding author for the JAMA Surgery article.

The authors reported no conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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