About
10-15% of patients with ovarian cancers may have genetic mutation of BRCA1 and
BRAC2 genes. Mutations in these genes
predispose women for breast cancer as well.
However, the most appropriate management of breast cancer risk in these
patients has not been defined.
A 2013
study evaluated164 patients had BRCA-ovarian cancer
(115 with BRCA1; 49 with BRCA2). Of these 164 patients, 152 developed ovarian
cancer prior to BRCA testing (median time to testing, 2.4 years [0.01-55 years]).
There were 46 deaths, but none were due to breast cancer. The 5- and 10-year
overall survival were 85% (95% confidence interval [CI]= 0.78, 0.90) and 68%
(95% CI = 0.59, 0.76), respectively. There were 18 metachronous breast cancer
diagnoses.
The conclusion of the study was for women with a
BRCA-associated epithelial ovarian cancer, the greatest risk of death was
from ovarian cancer and not breast cancer. Thus, breast cancer surveillance with mammography
and breast-clinical exam are a reasonable alternative to prophylactic bilateral mastectomy.
Reference: Domchek SM, Jhaveri K,
Patil S, Stopfer JE, Hudis C, Powers J, Stadler Z, Goldstein L, Kauff N,
Khasraw M, Offit K, Nathanson KL, Robson M.
Risk of metachronous breast cancer after BRCA mutation-associated
ovarian cancer. Cancer. 2013
Apr;119(7):1344-8.
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