In a study reported in JAMA Oncology, Choi et al found that risk-reducing salpingo-oophorectomy in women with BRCA1 or BRCA2 pathogenic variants was associated with a reduced risk of breast cancer within 5 years after surgery, with evidence of longer-term risk reduction among those with BRCA1 variants.
The study included data from 876 families enrolled in the Breast Cancer Family Registry between 1996 and 2000 that carried an inherited pathogenic variant in BRCA1 or BRCA2. The primary outcome measure was time to first primary breast cancer.
Key Findings
The 498 families with BRCA1 pathogenic variants consisted of 2,650 individuals, including 498 probands (88% White). Among these, a total of 166 (6.3%) underwent risk-reducing salpingo-oophorectomy. The 378 families with BRCA2 pathogenic variants consisted of 1,925 individuals, including 378 probands (79% White). Among these, a total of 144 (7.5%) underwent risk-reducing salpingo-oophorectomy.
Risk-reducing salpingo-oophorectomy was associated with a reduced risk of breast cancer within 5 years after surgery among both BRCA1 pathogenic variant carriers (hazard ratio [HR] = 0.28, 95% confidence interval [CI] = 0.10–0.63) and BRCA2 pathogenic variant carriers (HR = 0.19, 95% CI = 0.06–0.71).
Reduction in risk was attenuated more than 5 years after surgery among both BRCA1 pathogenic variant carriers (hazard ratio [HR] = 0.64, 95% confidence interval [CI] = 0.38–0.97) and BRCA2 pathogenic variant carriers (HR = 0.99, 95% CI = 0.84–1.00).
For BRCA1 and BRCA2 pathogenic variant carriers who underwent risk-reducing salpingo-oophorectomy at age 40, the cumulative risks of breast cancer were 49.7% (95% CI = 40.0%–60.3%) and 52.7% (95% CI = 47.9%–58.7%) by age 70. Among pathogenic variant carriers who did not undergo risk-reducing salpingo-oophorectomy, the cumulative risks were 61.0% (95% CI = 56.7%–66.0%) and 54.0% (95% CI = 49.3%–60.1%).
The investigators concluded, “Although the primary indication for risk-reducing salpingo-oophorectomy is the prevention of ovarian cancer, it is also critical to assess its association with breast cancer risk in order to guide clinical decision-making about … use and timing. The results of this case series suggest a reduced risk of breast cancer associated with risk-reducing salpingo-oophorectomy in the immediate 5 years after surgery in women carrying BRCA1 and BRCA2 pathogenic variants, and a longer-term association with cumulative breast cancer risk in women carrying BRCA1 pathogenic variants.”
Laurent Briollais, PhD, of Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by the U.S. National Cancer Institute, Canadian Institutes of Health Research, Canadian Breast Cancer Foundation, Breast Cancer Research Foundation, and others. For full disclosures of the study authors, visit jamanetwork.com.
