Oophorectomy Is Associated With Significantly Reduced Breast Cancer Mortality in Patients With BRCA1 Mutation or Estrogen Receptor–Negative Disease
In a retrospective analysis reported in JAMA Oncology, Metcalfe et al found that oophorectomy in patients with early-stage breast cancer was associated with significantly improved breast cancer survival in women harboring a BRCA1 mutation and in those with estrogen receptor–negative disease.
Study Details
The study involved data from 676 women with stage I or II breast cancer and a BRCA1 or BRCA2 mutation selected by pedigree review of families who received counseling at 12 clinical genetics centers. Patients were followed for up to 20 years after diagnosis between 1975 and 2008. Of the 676 women, 345 underwent oophorectomy after breast cancer diagnosis.
Survival Rates
The 20-year survival among all patients was 77.4%; 10-year breast cancer survival was 84.0% in BRCA1 carriers and 87.5% in BRCA2 carriers. In multivariate analysis, oophorectomy was associated with reduced breast cancer mortality (hazard ratio [HR] = 0.35, P = .005) and all-cause mortality (HR = 0.35, P < .001) in the entire cohort.
In multivariate analysis adjusting for age at diagnosis, year of diagnosis, BRCA gene, tumor size, nodal status, estrogen receptor status, receipt of chemotherapy, tamoxifen use, contralateral mastectomy, and ipsilateral mastectomy, oophorectomy was associated with a significant reduction in the risk of breast cancer death among BRCA1 carriers (HR = 0.38, P = .007), a nonsignificant reduction in risk among BRCA2 carriers (HR = 0.57, P = .23), a significant reduction among women with estrogen receptor–negative disease (HR = 0.07, P = .009) and a nonsignificant reduction among women with estrogen receptor–positive disease (HR = 0.76, P = .53).
The investigators concluded: “Oophorectomy is associated with a decrease in mortality in women with breast cancer and a BRCA1 mutation. Women with estrogen receptor–negative breast cancer and a BRCA1 mutation should undergo oophorectomy shortly after diagnosis.”
Steven A. Narod, MD, of Women’s College Research Institute, Toronto, is the corresponding author of the JAMA Oncology article.
The study was funded by the Canadian Breast Cancer Foundation, Ontario Chapter. The authors reported no potential 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®.
