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For BRCA1/2+ ovarian cancer survivors

Alexandra's picture
Alexandra
Posts: 1271
Joined: Jul 2012

This article was published on April 1, 2013 in Cancer magazine volume 119 issue 7 pages 1344-1348. To read full text go to Wiley Online library.

It's food for thought for those of us with hereditary ovarian cancer considering prophylactic mastectomy to reduce risk of breast cancer.

Risk of metachronous breast cancer after BRCA mutation–associated ovarian cancer

Abstract

BACKGROUND:

This study sought to estimate the risk of breast cancer (BC) after a diagnosis of ovarian cancer (OC) associated with mutation of the BRCA1/2 (breast cancer, early onset) genes (BRCA-OC).

METHODS:

The Memorial Sloan-Kettering Cancer Center and the University of Pennsylvania, clinical genetics databases were searched to identify women with BRCA-OC who participated in genetic testing and follow-up studies from 1995 to 2009. The primary objective was to determine the risk of developing BC after BRCA-OC. Overall survival (OS) and BC-free survival (BCFS) were determined by the Kaplan-Meier method; patients were censored at the time of last follow-up.

RESULTS:

A total of 164 patients had BRCA-OC (115 with BRCA1; 49 with BRCA2). Of these 164 patients, 152 developed OC prior to BRCA testing (median time to testing, 2.4 years [0.01-55 years]). Median follow-up from OC for those not developing BC was 5.8 years (0.25-55.6 years). There were 46 deaths, but none were due to BC. The 5- and 10-year OS were 85% (95% confidence interval [CI] = 0.78, 0.90) and 68% (95% CI = 0.59, 0.76), respectively. There were 18 metachronous BC diagnoses. The 5- and 10-year BCFS were 97% (95% CI = 0.92, 0.99) and 91% (95% CI = 0.82, 0.95), respectively. A subset of 64 women were tested either before or within 12 months of BRCA-OC. In this pseudo-incident subset, 5- and 10- year OS was 71% (95% CI = 0.53, 0.83) and 62% (95% CI = 0.44, 0.75), respectively, and 5- and 10-year BCFS were 100% and 87% (95% CI = 0.56, 0.96), respectively.

 

CONCLUSIONS:

OS was dominated by OC deaths. Metachronous BC risk was lower than reported for unaffected BRCA mutation carriers. These results support nonsurgical management of BC risk in women with BRCA-OC.

 
scatsm's picture
scatsm
Posts: 255
Joined: Apr 2013

Hi, I am new to this forum but have been reading various posts for a while now. My story highlights the other side of the above article.

 I was diagnosed in August 2011 with stage 3c ov ca. I was tested for the BRCA gene as my mother died of BC, and was positive for BRCA2. I was treated for the OVCA with 4 rounds of carbo/taxol, then a total hysterectomy/debulking surgery, then 4 more rounds of carbo/taxol. My CA125 was 2200 until after the surgery when it went to 4.

I was referred to a close surveillence program for BC, had the first mammogram, was fine; BUT at the breast MRI after 6 months (in September 2012) a small tumor was found. It was IDC triple positive. Because I had so recently ended chemo, and the chemos are so similar, I did not need further treatment other than a BMX, a year of Herceptin infusions every 3 weeks and 5 years of Armidex, an estrogen suppressor.

My sister, who is also BRCA2, had a PBSO after I was diagnosed with BC, and then had a BMX last month after going back and forth about whether to wait or not. To her surprise, the pathology showed an early, early lobular BC. What a miracle that she didn't wait! Six months from now it might have been a cancer that needed chemo.

I too feel like I dodged a bullet because the tumor was very tiny. Both my oncologists, for ovarian and breast cancer, agree that the major risk for me is the OvCa, but we all knew that, right?

Susan

Hearty Pioneer's picture
Hearty Pioneer
Posts: 137
Joined: Apr 2013

Alexandra, Thank you for posting this for us.  I think it is important be up to date on the latest research.

Alexandra's picture
Alexandra
Posts: 1271
Joined: Jul 2012

Susan and Hearty Pioneer,

I am so sorry that you had to face 2 different types of cancer. I found out that I was BRCA1+ (185delAG) 1 month after OvCa dx. I am in the high risk BC surveillance program (bi-annual exam + mammo + annual MRI) and so far I don't have BC. I was advised by my doctor against prophylactic mastectomy but obviously it's a personal decision and at some point I may change my mind.

Research described in the above article did not include BRCA1/2+ women who already had BC prior to OC. BRCA1/2+ OC survivors' risk of BC is still much higher than for the general population. But it's lower than risk of BRCA1/2+ "previvors" without OC. I don't know what the reasons are but I suspect that it has to do with oophorectomy and reduced estrogen production.

kimberly sue 63's picture
kimberly sue 63
Posts: 408
Joined: Apr 2012

I'm BRCA 1 and chose not to do a prophylactic mastectomy. I have had a mammogram and breast MRI over the last 6 months. I too was told by my oncologists that ovca was our biggest concern. Kim

kimberly sue 63's picture
kimberly sue 63
Posts: 408
Joined: Apr 2012

I'm BRCA 1 and chose not to do a prophylactic mastectomy. I have had a mammogram and breast MRI over the last 6 months. I too was told by my oncologists that ovca was our biggest concern. Kim

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