Data in on benefits of preventative surgeries for some...

[Soccermom]

http://abcnews.go.com/Health/OnCallP...ry?id=11516406


http://abcnews.go.com/Health/video/r...onger-11524998
http://abcnews.go.com/GMA/


There are three separate videos please look at all the ooptions onsite for video choices

[Rich66]

Print version via medscape:
http://www.medscape.com/viewarticle/727807

Dr. Rebbeck and colleagues investigated a cohort of nearly 2500 women with BRCA1 or BRCA2 mutations, 10% of whom chose to undergo a risk-reducing mastectomy and 38% of whom chose a risk-reducing salpingo-oophorectomy.
No breast cancers were diagnosed in the women who underwent mastectomy during the 3 years of prospective follow-up. However, 7% of those who did not undergo a prophylactic mastectomy during a similar follow-up period were diagnosed with breast cancer.

Overall, results showed that, compared with women who did not undergo prophylactic salpingo-oophorectomy, those who underwent the procedure had an overall lower risk for ovarian cancer, including those with previous breast cancer (6% vs 1%; HR, 0.14; 95% CI, 0.04 - 0.59) and those without previous breast cancer (6% vs 2%; HR, 0.28; 95% CI, 0.12 - 0.6); a lower risk for first diagnosis of breast cancer in BRCA1 carriers (20% vs 14%; HR, 0.63; 95% CI, 0.41 - 0.96) and BRCA2 carriers (23% vs 7%; HR, 0.36; 95% CI, 0.16 - 0.82); lower all-cause mortality (10% vs 3%; HR, 0.40; 95% CI, 0.26 - 0.61); lower breast-cancer-specific mortality (6% vs 2%; HR, 0.44; 95% CI, 0.26 - 0.76); and lower ovarian-cancer-specific mortality (3% vs 0.4%; HR, 0.21; 95% CI, 0.06 - 0.80).

[Soccermom]

Thanks for posting this Rich!

[Rich66]

Is there a statistician in the house?
Somehow comparing such different size groups seems distorting. Almost 4x more women went without surgery.

[Soccermom]

Maybe the full article from JAMA will elighten?
http://jama.ama-assn.org/cgi/content/full/304/9/967

[Jackie07]

Rich,

Since 10% of the women had mastectomy, that means 90% of the women did not. 90% x 2500 = 2250
Out of the 2250, 7% developed breast cancer, which means that
close to 158 women had developed breast cancer.

Since none of the 250 who underwent mastectomy had developed breast cancer in the 3 years followed, one can deduce that prophylactic mastectomy is a very effective way to prevent breast cancer in this high risk group.

In the ovarian cancer part, even though the reduction difference might be only 3 - 4 %, we are still talking about 45-62 women who could have avoided having ovarian cancer by having the preventive surgery.

I think the confusing part might be that how can women still have ovarian cancer if they had undergone prophylactic salpingo-oophorectomy. I guess cancer had grown out of the area where the ovaries used to be and was confirmed to be originated from ovarian tissues.

[Rich66]

I guess I was wondering whether with such a smaller amount getting the surgery, comparing percentages might be skewed. Another factor might be whether those that pursue surgery are more proactive on other fronts, healthwise.
But..I imagine in any organ specific cancer, removal of the organ pretty much removes that cancer risk.
I looked at the JAMA article and it didn't seem to footnote risk reduction of prophylactic mastectomy in non-BRCA types. Is it around 7%?
In one of those glass half empty/full analyses, the BRCA tag actually doesn't seem as damning as it might seem.

[Becky]

Well, the caveat is that these women were only followed for 3 years. I don't know ovarian cancer statistics for BRCA+ women but I do know the breast cancer stats.

If BRCA1+, a woman has a lifetime risk of getting bc of 60% - 80% (BRCA2+ is 45%- 60%). That is lifetime risk so basically out of 100 BRCA1+ women, by the end of their lifetime, 60-80 of them will have been diagnosed with bc. So, in 3 years time with a variety of aged women, how many will get cancer? Certainly not all who will. Perhaps some who have not gotten cancer won't but many, many will but perhaps not for 10 years from now. Secondly, these genes, in some families, affect the ovaries. You can see BRCA 1 families where the women all get ovarian cancer and perhaps a rare woman with breast cancer whereas another family where it is opposite.

So, if this study keeps up with following these women, you will see the cancer rates increase with those doing only survellience vs prophylactic surgeries.

[Rich66]

Well...with numbers like that..the benefit of mastectomy seems already established.
Although..current and future chemopreventatives might change that.

[Soccermom]

Jackie,
even after prophylactic surgery (oophrectomy) there is a residual risk,albeit small (1% ?) of developing Primary Peritoneal Cancer (PPC) which is cancer of the lining of the omentum, the sac which contains the abdominal organs.
It is treated the same way as Ovarian Cancer.

Rich, one of the things that make BRCA so insidious is early onset, it tends to be triple negative and lack the targeted therapies Her2 has,although they are touting great success with the PARP inhibitors. The other aspect is its inheritance pattern (autosomal dominant), each child having a 50% chance of inheriting the mutation, AND the myriad of other cancers these carriers (male and female) are at increased risk for (melanoma,pancreatic,esophageal,prostate etc.)


Here is the link to FORCE's page on risk % for both BRCA 1 & 2

http://www.facingourrisk.org/risk_ma...an_cancer.html


BECKY,I sent you a private message re: Dr Narod...

Warmly,Marcia

[Jackie07]

Thanks, Marcia.

It was the information from this support group that geared me toward genetic testing and then prophylactic hysterectomy/oophorectomy after learning my 2nd Brother's colon cancer surgery.

Besides BRCA1, BRCA2, there's another cluster called HNPCC that comprises Hereditary Non-polyposis colorectal cancer, endometrial cancer, urinary cancer, cancer of the female reproductive system...

Here's a good link provided by the Mayo Clinic:

http://www.mayoclinic.com/health/breast-cancer/WO00095