Risk Reducing Surgery vs. Active Surveillance for Breast Cancer Depends on Patients Age

• The risk of developing breast or ovarian cancer:
  • Is directly related to a woman’s age
  • An unaffected 30-year-old BRCA carrier:
    • Has a 66% and 12.2%:
      • Cumulative risk of developing breast cancer and ovarian cancer by age 80, respectively
  • By contrast, an unaffected 60-year-old BRCA carrier has a:
    • 48% and 3.8% cumulative risk of developing breast and ovarian cancer by age 80
  • When counseling women on the optimal timing of prophylactic surgeries:
    • It is important to consider the woman’s age:
      • As the cumulative risk decreases with each decade of life
    • Whereas risk-reduction surgery is a reasonable choice for a 40-year-old:
      • It is equally reasonable to pursue high-risk surveillance alone for a 60-year-old woman, if she so desires
  • The benefit of breast cancer risk-reduction associated with TAH-BSO:
    • Especially in postmenopausal women, has been questioned
    • Some studies report reduction in breast cancer risk associated with BSO:
      • But a recent study by Kotsopoulos found:
        • Only a reduction in breast cancer risk following BSO among premenopausal BRCA2 mutation carriers
      • The risk reduction seen in postmenopausal women is debated
• References:
  • Hartmann LC, Lindor NM. The role of risk-reducing surgery in hereditary breast and ovarian cancer. N Engl J Med. 2016;374(5):454-468.
  • Chen S, Iversen ES, Friebel T, Finkelstein D, Weber BL, Eisen A, et al. Characterization of BRCA1 and BRCA2 mutations in a large United States sample. J Clin Oncol. 2006;24(6):863-871.
  • Harris JR, Lippman ME, Morrow M, Osborne CK. Diseases of the Breast, Fifth Edition. Philadelphia, PA: Wolters Kluwer Health, 2014.
  • Kotsopoulos J, Huzarski T, Gronwald J, Singer CF, Moller P, Lynch HT, et al. Bilateral oophorectomy and breast cancer risk in BRCA1 and BRCA2 mutation carriers. J Natl Cancer Inst. 2017;109(1).

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