© 2001 by Oxford University Press
Journal of the National Cancer Institute, Vol. 93, No. 21, 1585,
November 7, 2001
© 2001 Oxford University Press
MEMORANDUM FOR: Science Writers and Editors on the Journal Press List
Prophylactic Mastectomy Is Associated With Reduced Breast Cancer Risk in Known BRCA1 and BRCA2 Mutation Carriers
November 1, 2001 (EMBARGOED FOR RELEASE 4 P.M. ET November 6)
Prophylactic removal of both breasts is associated with a reduced risk of a subsequent breast cancer by 89.5% to 100% among women who carry cancer-related BRCA1 or BRCA2 mutations.
Lynn Hartmann, M.D., at the Mayo Clinic, Rochester, Minn., and associates, identified 26 women with BRCA1 or BRCA2 alterations among a group of 214 high-risk women who had prophylactic mastectomies. None of these 26 women has developed breast cancer in the average 13.4 years of follow-up since their surgery. Calculations predicted that six to nine of these mutation carriers would have developed breast cancer if they had not had surgery. The authors conclude that prophylactic mastectomy is associated with a substantial reduction in the incidence of subsequent breast cancer not only in women identified as high-risk based on family history, but also in known BRCA1 or BRCA2 mutation carriers.
The current BRCA1/BRCA2 study is part of an original investigation that involved 214 women with a strong family history of breast cancer who had bilateral prophylactic mastectomies. Three of these 214 women developed breast cancer during the 14-year follow-up. On the basis of the number of breast cancers that developed in sisters (who did not have mastectomies) of these 214 women, the authors estimated that 38 breast cancers would have developed in the treated women had they not had surgery. Thus, surgery was associated with an approximately 90% reduction in breast cancer risk.
To determine the BRCA1/BRCA2 status of the 214 high-risk women, blood samples were collected from 176 of them. Analysis of the samples for BRCA1 and BRCA2 mutations detected 18 deleterious mutations and eight of uncertain clinical significance. None of these women has developed breast cancer. The investigators sought to determine the BRCA1/2 status of the three high-risk women (of 214) who developed breast cancer despite prophylactic mastectomy. Two were screened for BRCA1 and BRCA2 mutations and were negative. For the third, no blood sample was available, and thus her mutation status could not be determined.
The range of 89.5% to 100% reduction in breast cancer risk in BRCA carriers is explained by the unknown genetic status of one of the three women who developed breast cancer. If this woman is included in the calculations, the result is 89.5%, and if she is excluded, the result is 100%.
Editorialists Henry Lynch, M.D., Jane Lynch, B.S.N., and Wendy Rubinstein, Ph.D., M.D., say that news in medicine, such as the potential life-saving effects of bilateral prophylactic mastectomy, and its implementation in clinical practice, does not always travel fast. They note that BPM is controversial, in part due to concerns such as, "Will it work? Will patients accept it? Will physicians recommend it?" The initial study by Hartmann et al. showed that BPM was effective in high-risk women; now the proof is that it is also associated with risk reduction in BRCA1/BRCA2 mutation carriers. They suggest that only time will resolve the public health impact of these findings.
Contact: Mary Lawson, Mayo Clinic, (507) 266-0810; fax: (507) 284-8713; lawson.mary18{at}mayo.edu. Editorial: Lori Elliott-Bartle, Creighton University, (402) 280-2607; fax (402) 280-2549; lelliott{at}creighton.edu.
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Hartmann LC, Sellers TA, Schaid DJ, Frank TS, Soderberg CL, Sitta DL, et al. Efficacy of bilateral prophylactic mastectomy in BRCA1 and BRCA2 gene mutation carriers. J Natl Cancer Inst 2001;93:1633–7.
Editorial: Lynch HT, Lynch JF, Rubinstein WS. Prophylactic mastectomy: obstacles and benefits. J Natl Cancer Inst 2001;93:1586–7.
Note: This memo to reporters is from the Journal staff and is not an official release of the National Cancer Institute (NCI) or Oxford University Press (OUP) nor does it reflect NCI or OUP policy. In addition, unless otherwise stated, all articles and items published in the Journal reflect the individual views of the authors and not necessarily the official points of view held by NCI, any other component of the U.S. government, OUP, or the organizations with which the authors are affiliated. Neither NCI nor any other component of the U.S. government nor OUP assumes any responsibility for the completeness of the articles or other items or the accuracy of the conclusions reached therein.
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