Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:


Mastectomy dramatically reduces breast cancer risk among women with BRCA1/2 mutations


Short-Term Hormone Replacement Therapy Safe Following Removal of Ovaries

Two studies from the Abramson Cancer Center at the University of Pennsylvania appearing online in the Journal of Clinical Oncology (JCO) have important implications for women with BRCA1 and BRCA2 mutations. The first study shows that bilateral prophylactic mastectomy can reduce breast cancer risk by more than 90% in women with BRCA1 and BRCA2 mutations, and may be even more effective when performed concurrently with or following oophorectomy. The second study shows that women undergoing prophylactic oophorectomy (removal of ovaries) can take short-term hormone replacement therapy (HRT) to combat the associated symptoms of menopause without fear of significantly increasing breast cancer risk.

Although the removal of the breasts and the ovaries does not completely prevent breast and ovarian cancer, researchers strongly recommend that all women with the mutations undergo oophorectomy at the completion of child bearing, based on previous studies showing that this procedure reduces ovarian cancer risk by at least 90%. Results of these studies will be published online at on February 23, 2004 at 6:00 p.m. (ET).

Bilateral Mastectomy Significantly Lowers Breast Cancer Risk in High-Risk Women

The first study to calculate the risk reduction from bilateral mastectomy in BRCA1 and BRCA2 mutation carriers evaluated 483 women from 11 sites in the United States, Canada, United Kingdom and the Netherlands over six years.

Breast cancer was diagnosed in two of the 105 women (1.9%) who had bilateral prophylactic mastectomy, compared to 184 of the 378 (48.7%) who did not undergo the procedure. Mastectomy reduced breast cancer risk by approximately 95% among women with prior or concurrent prophylactic oophorectomy, and by 90% among women with intact ovaries.

"Our study shows that bilateral prophylactic mastectomy markedly reduces the risk of breast cancer in women who are genetically predisposed to the disease," said Dr. Barbara Weber, MD, Professor of Medicine and Genetics at the University of Pennsylvania, an investigator in the Abramson Family Cancer Research Institute, and senior author of both studies. "Women undergoing this procedure should feel confident that if they choose this risk management option, it will reduce their risk of breast cancer to almost zero."

Dr. Weber noted that while bilateral mastectomy is optional for BRCA1 and BRCA2 mutation carriers, bilateral prophylactic oophorectomy at the completion of childbirth should be the standard of care for these at-risk women, since it has been shown to reduce risk of ovarian cancer by 95% and breast cancer by 50%.

"Undergoing prophylactic mastectomy is a very personal decision. Women who choose to have their breasts removed in addition to their ovaries should know that prophylactic mastectomy is an option that really works, and makes taking HRT after oophorectomy even safer," she added.

Hormone Replacement After Prophylactic Oophorectomy Safe for Women with BRCA1/2 Mutations

The second study from the University of Pennsylvania Abramson Cancer Center used a mathematical model to assess the expected outcomes of prophylactic oophorectomy – the surgical removal of both ovaries – and subsequent hormone replacement therapy in women with BRCA1 and BRCA2 mutations.

The model, based on the most current epidemiological data, predicts that prophylactic oophorectomy significantly increases life expectancy in women with BRCA1 and BRCA2 mutations, and that short-term HRT – used to treat the uncomfortable side effects associated with oophorectomy-induced menopause – did not significantly alter the gain in life expectancy, when stopped by age 50. The gain in life expectancy from oophorectomy ranged from 3.34 to 4.65 years, depending on age at oophorectomy.

"Women at increased risk for breast and ovarian cancer have been reluctant to undergo oophorectomy since the data from the Women’s Health Initiative on HRT was released," said Dr. Katrina Armstrong, lead author of the study and Assistant Professor of Medicine and Epidemiology at the University of Pennsylvania School of Medicine. "Our study shows that removing the ovaries is an essential risk reduction strategy for BRCA1 and BRCA2 carriers, which shouldn’t be avoided because of confusion or fear about hormone replacement therapy."

The researchers noted that although HRT was associated with relatively small changes in life expectancy when stopped by age 50, larger reductions in life expectancy were found when the therapy was continued indefinitely, beyond the age of natural menopause.

"This analysis shows that the impact of HRT on life expectancy for the short term is relatively minor. Women undergoing prophylactic oophorectomy should feel free to make their decision about hormone replacement therapy based on quality of life rather than life expectancy," Dr. Armstrong said.

An accompanying editorial by Judy Garber, MD, MPH and Anne-Renee Hartman, MD of the Dana-Farber Cancer Institute in Boston supported the findings, but cautioned about the widespread prescription of HRT following oophorectomy.

"The Armstrong model is a huge step forward and should help ease physician concerns about recommending short-term HRT for menopausal symptoms," Garber and Hartman said. "However, many aspects of the effect of HRT on breast cancer risk in mutation carriers remain unclear. Until there are more data from mutation carriers with which to evaluate the model, physicians should carefully weigh the results of this analysis and other emerging data in their recommendations to young BRCA1 and BRCA2 carriers."

"Bilateral Prophylactic Mastectomy Reduces Breast Cancer Risk in BRCA1 and BRCA2 Mutation Carriers." Timothy Rebbeck, et al Abramson Family Cancer Research Institute, University of Pennsylvania, Philadelphia, PA.

"Hormone Replacement Therapy and Life Expectancy After Prophylactic Oophorectomy in Women with BRCA1/2 Mutations: A Decision Analysis." Katrina Armstrong, et al, Abramson Family Cancer Research Institute, University of Pennsylvania, Philadelphia, PA.

The Journal of Clinical Oncology is the semi-monthly peer-reviewed journal of the American Society of Clinical Oncology (ASCO), the world’s leading professional society representing physicians who treat people with cancer.

Carrie Housman | EurekAlert!

More articles from Health and Medicine:

nachricht NIH scientists describe potential antibody treatment for multidrug-resistant K. pneumoniae
14.03.2018 | NIH/National Institute of Allergy and Infectious Diseases

nachricht Researchers identify key step in viral replication
13.03.2018 | University of Pittsburgh Schools of the Health Sciences

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Locomotion control with photopigments

Researchers from Göttingen University discover additional function of opsins

Animal photoreceptors capture light with photopigments. Researchers from the University of Göttingen have now discovered that these photopigments fulfill an...

Im Focus: Surveying the Arctic: Tracking down carbon particles

Researchers embark on aerial campaign over Northeast Greenland

On 15 March, the AWI research aeroplane Polar 5 will depart for Greenland. Concentrating on the furthest northeast region of the island, an international team...

Im Focus: Unique Insights into the Antarctic Ice Shelf System

Data collected on ocean-ice interactions in the little-researched regions of the far south

The world’s second-largest ice shelf was the destination for a Polarstern expedition that ended in Punta Arenas, Chile on 14th March 2018. Oceanographers from...

Im Focus: ILA 2018: Laser alternative to hexavalent chromium coating

At the 2018 ILA Berlin Air Show from April 25–29, the Fraunhofer Institute for Laser Technology ILT is showcasing extreme high-speed Laser Material Deposition (EHLA): A video documents how for metal components that are highly loaded, EHLA has already proved itself as an alternative to hard chrome plating, which is now allowed only under special conditions.

When the EU restricted the use of hexavalent chromium compounds to special applications requiring authorization, the move prompted a rethink in the surface...

Im Focus: Radar for navigation support from autonomous flying drones

At the ILA Berlin, hall 4, booth 202, Fraunhofer FHR will present two radar sensors for navigation support of drones. The sensors are valuable components in the implementation of autonomous flying drones: they function as obstacle detectors to prevent collisions. Radar sensors also operate reliably in restricted visibility, e.g. in foggy or dusty conditions. Due to their ability to measure distances with high precision, the radar sensors can also be used as altimeters when other sources of information such as barometers or GPS are not available or cannot operate optimally.

Drones play an increasingly important role in the area of logistics and services. Well-known logistic companies place great hope in these compact, aerial...

All Focus news of the innovation-report >>>



Industry & Economy
Event News

Ultrafast Wireless and Chip Design at the DATE Conference in Dresden

16.03.2018 | Event News

International Tinnitus Conference of the Tinnitus Research Initiative in Regensburg

13.03.2018 | Event News

International Virtual Reality Conference “IEEE VR 2018” comes to Reutlingen, Germany

08.03.2018 | Event News

Latest News

Wandering greenhouse gas

16.03.2018 | Earth Sciences

'Frequency combs' ID chemicals within the mid-infrared spectral region

16.03.2018 | Physics and Astronomy

Biologists unravel another mystery of what makes DNA go 'loopy'

16.03.2018 | Life Sciences

Science & Research
Overview of more VideoLinks >>>