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Contralateral mastectomy improves survival in women with BRCA1/2-associated breast cancer

  • Epidemiology
  • Published:
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Abstract

BRCA1/2 mutation carriers with breast cancer are at high risk of contralateral disease. Such women often elect to have contralateral risk-reducing mastectomy (CRRM) to reduce the likelihood of recurrence. This study considers whether CRRM improves overall survival. 105 female BRCA1/2 mutation carriers with unilateral breast cancer who underwent CRRM were compared to controls (593 mutation carriers and 105 specifically matched) not undergoing CRRM and diagnosed between 1985 and 2010. Survival was assessed by proportional hazards models, and extended to a matched analysis using stratification by risk-reducing bilateral salpingo-oophorectomy (RRBSO), gene, grade and stage. Median time to CRRM was 1.1 years after the primary diagnosis (range 0.0–13.3). Median follow-up was 9.7 years in the CRRM group and 8.6 in the non-CRRM group. The 10-year overall survival was 89 % in women electing for CRRM (n = 105) compared to 71 % in the non-CRRM group (n = 593); p < 0.001. The survival advantage remained after matching for oophorectomy, gene, grade and stage: HR 0.37 (0.17–0.80, p = 0.008)—CRRM appeared to act independently of RRBSO. CRRM appears to confer a survival advantage. If this finding is confirmed in a larger series it should form part of the counselling procedure at diagnosis of the primary tumour. The indication for CRRM in women who have had RRBSO also requires further research.

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Acknowledgments

FL and DGE are supported by the Manchester NIHR Biomedical Research Centre; DGE, AH and AB by the Genesis Breast Cancer Prevention Appeal. AH is supported by Breakthrough Breast Cancer, DGE is an NIHR Senior Investigator. IB is supported by the MRC Health eResearch Centre. The study sponsor had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. The corresponding author confirms that he had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All aspects of this study comply with the current laws of the United Kingdom of Great Britain.

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Authors and Affiliations

  1. Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK

    D. Gareth R. Evans, Sarah L. Ingham, Fiona Lalloo & Anthony Howell

  2. Genetic Medicine, Manchester Academic Health Science Centre (MAHSC), Central Manchester Foundation Trust, St. Mary’s Hospital, The University of Manchester, Oxford Road, Manchester, M13 9WL, UK

    D. Gareth R. Evans

  3. Manchester Breast Centre, Manchester Cancer Research Centre, The University of Manchester, Withington, Manchester, M20 4BX, UK

    D. Gareth R. Evans, Andrew Baildam & Anthony Howell

  4. Department of Breast Surgery, University Hospital of South Manchester NHS Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK

    Andrew Baildam

  5. Department of Plastic Surgery, The Christie NHS Foundation Trust, Withington, Manchester, M20 4BX, UK

    Gary L. Ross

  6. Centre for Health Informatics, Institute of Population Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK

    Sarah L. Ingham & Iain Buchan

Authors
  1. D. Gareth R. Evans
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  2. Sarah L. Ingham
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  3. Andrew Baildam
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  4. Gary L. Ross
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  5. Fiona Lalloo
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  6. Iain Buchan
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  7. Anthony Howell
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Corresponding author

Correspondence to D. Gareth R. Evans.

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Evans, D.G.R., Ingham, S.L., Baildam, A. et al. Contralateral mastectomy improves survival in women with BRCA1/2-associated breast cancer. Breast Cancer Res Treat 140, 135–142 (2013). https://doi.org/10.1007/s10549-013-2583-1

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  • DOI: https://doi.org/10.1007/s10549-013-2583-1

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