Blog | Wednesday, September 1, 2010

QD: News Every Day--Risk-reducing surgeries may spare lives following breast cancer


New evidence supports risk-reducing mastectomy and salpingo-oophorectomy for women with the BRCA1 and BRCA2 genetic mutations, according to newly published research.

Researchers wrote in the Journal of the American Medical Association that no breast cancers were diagnosed in a cohort of 247 women with risk-reducing mastectomy, compared to 98 women among 1,372 breast cancer patients without it.

Illustration by David Cutler from ACP InternistFurthermore, women who underwent salpingo-oophorectomy had a lower risk of ovarian cancer, including those with prior breast cancer (6% vs 1%, respectively; hazard ratio [HR], 0.14; 95% confidence interval [CI], 0.04-0.59) and those without prior breast cancer (6% vs 2%; HR, 0.28 [95% CI, 0.12-0.69]).

An editorialist told Reuters that 10%-20% of breast and ovarian cancers are due to BRCA1 or BRCA2 mutations, so prophylactic surgery can save many patients. And, she added, it falls on primary care physicians, gynecologists and the patients themselves to be aware that genetic tests are available.

The editorial from JAMA continued, "From the time BRCA1 and BRCA2 were identified and testing for them became an option, not all primary care physicians have been convinced of the benefits of hereditary risk assessment. However, risk-reducing surgery has been proved effective--and this evidence has emerged because of the willingness to adopt testing, identify women at risk, and study interventions in this specific population."

The issue is becoming more important, as the survival rate of breast cancer overall has risen to more than 80%, as ACP Internist examined in May 2009. Patient need to be checked not only for cancers, but then for the host of ailments that might get lost to follow-up as this population ages.

How do physicians decide which patients would most benefit from which new prevention and treatment strategies? ACP Internist next reported in June 2009 how detection and prevention are changing in the face of new tests and treatments.