In the Journals

Women with BRCA-associated ovarian cancer have low risk for subsequent breast cancer

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December 23, 2014

Women with epithelial ovarian cancer who harbor BRCA mutations appear to be at low risk for developing breast cancer, according to results of a retrospective database review.

The findings suggest current breast cancer surveillance protocols in this patient population may need to be reassessed, Alexandra Gangi, MD, of the division of surgical oncology at Cedars-Sinai Medical Center, and colleagues concluded.

Gangi and colleagues identified 364 patients treated for epithelial ovarian cancer between Jan. 1, 1998, through Dec. 31, 2012. Mean age at diagnosis was 49.5 years (range, 28-89).

About one-third of patients (37%; n=135) harbored a BRCA1 or BRCA2 mutation. Among this subset, 80 (59.3%) patients underwent annual mammography, and 60 (44.4%) underwent annual breast MRI. Thirteen patients (9.6%) underwent bilateral preventive mastectomy after epithelial ovarian cancer diagnosis.

Results showed 12 (8.9%) of the patients with BRCA mutations subsequently developed breast cancer.

The median time from diagnosis of epithelial ovarian cancer to diagnosis of breast cancer was 50.5 months. Mammography was the most common method of breast cancer diagnosis (58.3%; n=7). Three (25%) patients had a palpable mass, and two (16.7%) had breast cancer detected during prophylactic mastectomy.

All cases of breast cancer were early stage (stage 0 to stage II). Four patients (33.3%) underwent adjuvant chemotherapy.

At median follow-up of 6.3 years, four (33.3%) of the 12 women with breast cancer had died of relapsed epithelial ovarian cancer.

Researchers reported a 10-year OS rate of 17% for the entire 135-patient cohort.

“Our data suggest that the risk of breast cancer after BRCA-associated ovarian cancer is low, that aggressive management with annual breast MRI for surveillance may not be indicated, and that annual mammography may be sufficient for following these high-risk patients,” Gangi and colleagues wrote. “Furthermore, guidelines suggest that — after a disease-free interval of 12 months — routine screening with breast examination and mammography may be warranted for patients with cancers of a lower stage.”

Disclosure:  The researchers report no relevant disclosures.

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