Patients with a history of breast cancer who are carriers of BRCA1 and BRCA2 pathogenic variants benefit from undergoing bilateral salpingo-oophorectomy, the results of a retrospective cohort study published in The Lancet Oncology showed. Women who had their ovaries and fallopian tubes removed demonstrated a reduced risk of all-cause mortality, breast cancer-specific mortality, and second non-breast cancer development.
Additionally, these benefits were seen without an increased risk of other adverse long-term health outcomes, such as heart diseases.
“We know that removing the ovaries and fallopian tubes dramatically reduces the risk of ovarian cancer, but there’s been a question mark over the potential unintended consequences that might arise from the sudden onset of menopause that this causes,” first author Hend Hassan, MPhil, a PhD student at the Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, and Wolfson College in Cambridge, stated. “Reassuringly, our research has shown that for women with a personal history of breast cancer, this procedure brings clear benefits in terms of survival and a lower risk of other cancers without the adverse side effects such as heart conditions or depression.”
Study Methods and Results
The study authors sought to determine the overall impact of bilateral salpingo-oophorectomy in women with breast cancer who are carriers of BRCA1 and BRCA2 gene variants without using a randomized, controlled clinical trial, as that would put patients in the control group at risk of developing ovarian cancer.
Instead, the investigators examined electronic health records from the National Cancer Registration Dataset, data from the National Health Service in the United Kingdom in collaboration with the National Disease Registration Service, and patient data from the Hospital Episode Statistics–Admitted Patient Care (HES-APC) dataset to identify patients who had undergone bilateral salpingo-oophorectomy.
A total of 1,674 carriers of BRCA1, 1,740 carriers of BRCA2, and 9 carriers of both BRCA1 and BRCA2 were included in the analysis (n = 3,423).
The investigators noted that rates of bilateral salpingo-oophorectomy were lower among Black women and Asian women. On the other hand, rates were higher in women living in more socioeconomically prosperous areas.
Bilateral salpingo-oophorectomy was associated with a reduced risk of all-cause mortality for all BRCA1 or BRCA2 carriers (hazard ratio [HR] = 0.52; 95% confidence interval [CI] = 0.41–0.64). The surgery was also associated with a reduced risk of breast cancer-specific mortality for both BRCA1 (HR = 0.62; 95% CI = 0.42–0.92) and BRCA2 carriers (HR = 0.48; 95% CI = 0.34-0.68). A reduced risk of second non-breast cancer was also observed with bilateral salpingo-oophorectomy for patients who had both BRCA1 and BRCA2 (HR = 0.59; 95% CI = 0.37–0.94).
Surgery was not associated with an increased risk of cardiovascular diseases (HR = 0.73; 95% CI = 0.53–1.01), ischemic heart disease (HR = 1.04; 95% CI = 0.48–2.26), cerebrovascular disease (HR = 0.32; 95% CI = 0.11–0.90), non-breast cancer specific mortality (HR = 0.72; 95% CI = 0.45–1.16), contralateral breast cancer (HR = 1.18; 95% CI = 0.64–2.16), or depression (HR = 0.94; 95% CI = 0.62–1.42).
“Our findings will be crucial for [counseling] women with cancer linked to one of the BRCA1 and BRCA2 variants, allowing them to make informed decisions about whether or not to opt for this operation,” stated senior author Antonis C. Antoniou, PhD, from the Department of Public Health and Primary Care at the University of Cambridge.
Disclosure: For full disclosures of the study authors, visit thelancet.com.
