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Predictors of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers
Open accessAbstract
PURPOSE: The objective of this study was to estimate the risk of contralateral breast cancer in BRCA1 and BRCA2 carriers; and measure the extent to which host, family history, and cancer treatment-related factors modify the risk. PATIENTS AND METHODS: Patients were 810 women, with stage I or II breast cancer, for whom a BRCA1 or BRCA2 mutation had been identified in the family. Patients were followed from the initial diagnosis of cancer until contralateral mastectomy, contralateral breast cancer, death, or last follow-up. RESULTS: Overall, 149 subjects (18.4%) developed a contralateral breast cancer. The 15-year actuarial risk of contralateral breast cancer was 36.1% for women with a BRCA1 mutation and was 28.5% for women with a BRCA2 mutation. Women younger than 50 years of age at the time of breast cancer diagnosis were significantly more likely to develop a contralateral breast cancer at 15 years, compared with those older than 50 years (37.6 vs 16.8%; P=0.003). Women aged <50 years with two or more first-degree relatives with early-onset breast cancer were at high risk of contralateral breast cancer, compared with women with fewer, or no first-degree relatives with breast cancer (50 vs 36%; P=0.005). The risk of contralateral breast cancer was reduced with oophorectomy (RR 0.47; 95% CI 0.30-0.76; P=0.002). CONCLUSION: The risk of contralateral breast cancer risk in BRCA mutation carriers declines with the age of diagnosis and increases with the number of first-degree relatives affected with breast cancer. Oophorectomy reduces the risk of contralateral breast cancer in young women with a BRCA mutation.
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“We observed that family history is a predictor of CBC risk in both noncarriers and mutation carriers, which is in line with previous literature.19,21”
From Impact of Age at Primary Breast Cancer on Contralateral Breast Cancer Risk in BRCA1/2 Mutation Carriers (2016) · cites this paper as [21]
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“Genetic testing is relevant for his at risk relatives, including his sister who was diagnosed at 41 with breast cancer, since studies suggest that woman with BRCA2 mutations have an increased risk of contralateral breast cancer in the absence of intervention [15] and that the risk of ovarian, primary peritoneal and fa…”
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“However, it must be remarked that in the basal type subset of patients there is a higher proportion of BRCA-1 and -2 mutant patients [20], and that BRCA-1 and -2 mutant patients carry a high risk of CBC [21].”
BackgroundNomogram to predict contralateral breast cancer risk in breast cancer survivors
Tong, J., Tan, D., Ma, J., Hu, Y., & Li, M. (2021) · Medicine · doi:10.1097/md.0000000000027595 · Cited by 8
“The lifetime risk of BC and of CBC for women who carry a BRCA mutation is very high.([30]) Reiner et al have also demonstrated that women with a family history of BC have a higher risk of CBC even after a negative BRCA result.”
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BackgroundRisk of Ipsilateral and Contralateral Cancer in BRCA Mutation Carriers with Breast Cancer
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“Multiple studies showed that a younger age at the onset of first breast cancer is associated with a higher contralateral breast cancer risk [23-26].”
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“Studies of populations in the USA or Europe have shown that BRCA1 and BRCA2 mutations have a 24–35% and 19–29% risk of developing contralateral breast cancer within 10 years of their first breast cancer [8, 31–33].”
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Who should get a contralateral prophylactic mastectomy for breast cancer?
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“The number of other affected family members in this scenario and the tumor subtype further impact CBC risk for such a patient.(4,5) However, there are no models incorporating all of these key riskassociated variables to allow for an accurate estimate of CBC risk.”
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“Sensitivity analyses were conducted excluding studies that (1) reported risk estimates among BRCA1/2 mutation carriers [18, 22, 29, 36] and (2) assessed low-dose tamoxifen use [31].”
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“Early onset ofBC tends to occur with hormone receptor negativity in larger and more aggressive, high grade tumors with hormone receptor negativity, and HER2 overexpression (Assi et al., 2013), with greater risk of contralateral breast cancer in 15 years (Metcalfe et al., 2011).”
BackgroundModifiable and Nonmodifiable Risk Factors for Breast Cancer: A Comprehensive Scoping Review
Momenimovahed, Z., Shahabinia, Z., Allahqoli, L., & Salehiniya, H. (2026) · International Journal of Breast Cancer · doi:10.1155/ijbc/8689986 · Cited by 3
“Studies have indicated that the association of breast cancer in women with a first-and second-degree family history is stronger than that in those with no family history [15, 16].”
Tonouo, P. D., Bell, E. D., Tiofack, A. A. Z., Ndounga, E., Ananga, S. N., Atenguena, E., Simo, G., Njouendou, A. J., & Lueong, S. (2022) · Medical Oncology · doi:10.1007/s12032-022-01877-8 · Cited by 3
“Furthermore, although mutations in high penetrance genes such as BRCA1 and BRCA2 are associated with very high risk of contralateral breast cancer, these mutations are only seen in a small fraction of patients with EOBRCA [6, 7].”
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“P/LP variants in BRCA1 confer a higher risk for breast cancer compared to P/LP variants in BRCA2 (Saslow et al.”
BackgroundInfluentialRecurrence Patterns and Long-Term Results After Curative Surgery for Patients With Breast Cancer
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“57 Hence, the utilization of BCT for patients with SBC necessitates thoughtful deliberation and individualized decision-making strategies in clinical practice.”
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The EUSOMA recommendations for the management of young women with breast cancer
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“BRCA1/2 carriers more often present with early-onset breast–ovarian cancer (see review by Robson, 2004) and bilateral breast cancer (Metcalfe et al. , 2011a, 2011b).”
Metcalfe, K. A., Eisen, A. F., Wright, F. C., Poll, A., Candib, A., McCready, D. R., Cil, T. D., Armel, S. R., Silberman, Y., Brennenstuhl, S., et al. (2021) · Breast Cancer Research and Treatment · doi:10.1007/s10549-021-06457-4 · Cited by 3
“Bilateral mastectomy has been shown to reduce the risk of contralateral breast cancer for women with a BRCA1 or BRCA2 mutation by 97% [2, 4].”
BackgroundSelf-citationLammert, J., Basrai, M., Struck, J., Hartmann, O., Engel, C., Bischoff, S. C., Berling-Ernst, A., Halle, M., Kiechle, M. B., & Grill, S. (2022) · Geburtshilfe und Frauenheilkunde · doi:10.1055/a-1811-2164 · Cited by 3
“They also have a high risk of developing contralateral [24] or ipsilateral cancer [25].”
Second Malignant Neoplasms in Pediatric Oncology Patients: A Single Center Experience
Tanyıldız, H. G., Yeşil, Ş., Tekgündüz, S. A., Candir, M. O., Toprak, Ş., Bozkurt, C., Yüksek, N., Şahin, G., & Ertem, U. (2017) · Gazi Medical Journal · doi:10.12996/gmj.2017.50 · Cited by 2
“A familial cancer tendency can be an important risk factor in the development of both primary and secondary malignancies in children (14-19).”
BackgroundCabañuz, M. A., Bretón, M. D., Ezquerro, J. C., del Amo, M. D. A., & Sánchez, A. T. G. (2020) · Cirugía Española (English Edition) · doi:10.1016/j.cireng.2020.11.009 · Cited by 2
Risk-reducing mastectomy in mutation carriers
Zaborowski, A. M., & Boland, M. R. (2024) · British journal of surgery · doi:10.1093/bjs/znae264 · Cited by 2
Breast cancer inBRCAmutation carriers: breast-conserving therapy or bilateral mastectomy?
Murphy, J. O., & Sacchini, V. (2013) · Clinical Practice · doi:10.2217/cpr.13.72 · Cited by 2
Management of BRCA mutation carriers
Paris, I., Giorgio, D. D., Palluzzi, E., Garganese, G., Terribile, D. A., Fragomeni, S. M., D’Archi, S., Scambia, G., & Masetti, R. (2018) · Translational Cancer Research · doi:10.21037/tcr.2018.01.23 · Cited by 1
Rugo, H. S., Majure, M. C., Dragun, A. J., Buxton, M., & Esserman, L. J. (2017) · Wiley eBooks · doi:10.1002/9781119000822.hfcm109 · Cited by 2
Friedman, D. L. (2014) · Elsevier eBooks · doi:10.1016/b978-1-4557-2865-7.00062-x · Cited by 2
van der Sangen, M. J. C. (2013) · doi:10.26481/dis.20131127ms · Cited by 2
Michaelson‐Cohen, R., Beeri, R., Golomb, E., & Levy‐Lahad, E. (2016) · Springer eBooks · doi:10.1007/978-3-319-19674-9_22 · Cited by 1
Hereditary breast and ovarian cancer – University Hospital of Split experiences
Miše, B. P., Katalenić, M., Hrepić, D., Kuret, S., & Hofman, I. D. (2023) · Libri Oncologici Croatian Journal of Oncology · doi:10.20471/lo.2023.51.01.02 · Cited by 1
“A prospective cohort study with more than 2,000 BrCam breast cancer patients found that the risk of contralateral breast cancer 20 years after initial breast cancer diagnosis was 40% for BRCA1 and 26% for BRCA2(9).”
Lin, J., Lin, Z., Chen, Y., Wang, X., Huang, Y.-F., Zhang, H., Zhu, L. F., Xu, Z., Gao, X., Zhang, Y., et al. (2025) · Annals of Medicine · doi:10.1080/07853890.2025.2493769 · Cited by 1
“Germline mutations and somatic mutations are common and variable in oncological diseases, which may lead to the occurrence and contribute to the pathogenesis of MPMTs. Mutations in BRCA1 and BRCA2 are associated with high risks of second primary breast cancer or ovarian cancer [10].”
Prophylactic Mastectomy and Risk-Reducing Salpingo-oophorectomy in BRCA1/2 Mutation Carriers
Maxwell, K. N., & Domchek, S. M. (2012) · Current Breast Cancer Reports · doi:10.1007/s12609-012-0086-4 · Cited by 1
Self-citationAssessing, Counseling, and Treating Patients at High Risk for Breast Cancer
Clifford, E., Hughes, K. S., Roberts, M. E., Pirzadeh-Miller, S. M., & McLaughlin, S. A. (2016) · Annals of Surgical Oncology · doi:10.1245/s10434-016-5399-5 · Cited by 1
“If the same patient had two or more first-degree relatives with breast cancer, the CBC risk was 68 %.(29)”
BackgroundScreening and Prevention of Ovarian Cancer
Kobayashi, H. (2017) · Comprehensive gynecology and obstetrics · doi:10.1007/978-981-10-4160-0_4 · Cited by 1
Prophylactic Mastectomy and Breast Reconstruction in Patients at High Risk for Breast Cancer
Chu, C. K.-C., & Bedrosian, I. (2020) · Current Breast Cancer Reports · doi:10.1007/s12609-020-00355-2 · Cited by 1
Analysis of bilateral breast carcinomas
Pasetto, C. V., Batista, B. R., Budel, L. R., Andreoli, M. D. N., & Budel, V. M. (2021) · Mastology · doi:10.29289/2594539420200026 · Cited by 1
Kiechle, M. B., & Grill, S. (2021) · Journal für Gynäkologische Endokrinologie/Schweiz · doi:10.1007/s41975-021-00192-1 · Cited by 1
Management of Hereditary Breast Cancer: An Overview
Kattepur, A. K., & Gopinath, K. S. (2022) · Springer eBooks · doi:10.1007/978-981-16-4546-4_18 · Cited by 1
Larionov, A. A., Fewings, E., Redman, J., Goldgraben, M. A., Clark, G. R., Boice, J. D., CONCANNON, P. J., Bernstein, J. L., Conti, D. V., the WECARE Study Collaborative Group, et al. (2023) · Cancers · doi:10.3390/cancers15020415 · Cited by 1
“5% per year after diagnosis of the first BC [24], which is at least five times higher than in non-carriers [2,3].”
BackgroundGenetic Risk Prediction in Breast Cancer
Nguyen, A., Plichta, J. K., Cintolo-Gonzalez, J., Kartal, K., Griffin, M., & Hughes, K. S. (2017) · Springer eBooks · doi:10.1007/978-3-319-60336-0_15 · Cited by 1
Düzkale, N., & Teker, H. T. (2021) · Oncology in Clinical Practice · doi:10.5603/ocp.2020.0026 · Cited by 1
“In another study, 10-year contralateral breast cancer risk in BRCA1 carriers was reported to be 24%, and the same risk for BRCA2 carriers was 19% [6].”
BackgroundKiechle, M. B., & Grill, S. (2020) · Der Gynäkologe · doi:10.1007/s00129-020-04662-8 · Cited by 1
Manturova, N. E., Mistakopulo, F. N., Зикиряходжаев, А. Д., Portnoy, S. M., Sobolevskiy, V. A., Крохина, О. В., & Sukhotko, A. S. (2020) · Plastic Surgery and Aesthetic Medicine · doi:10.17116/plast.hirurgia20200415 · Cited by 1
Surgical Options for Primary Prevention: Prophylactic Mastectomy and Oophorectomy
Murphy, J. O., & Sacchini, V. (2020) · Springer eBooks · doi:10.1007/978-3-030-41207-4_18 · Cited by 1
Genetic/Familial High-Risk Screening: MRI Alone?
Marino, M. A., Clauser, P., & Helbich, T. H. (2020) · Springer eBooks · doi:10.1007/978-3-030-41207-4_10 · Cited by 1
Present Options in the Prevention of Breast Cancer
Russo, J. (2021) · Springer eBooks · doi:10.1007/978-3-030-72815-1_7 · Cited by 1
Lee, M. K., & Robson, M. E. (2023) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djad129 · Cited by 1
Knowledge, Attitudes, and Utilization of BRCA Testing Among Obstetricians and Gynecologists
Nassef, S. A. (2012) · Digital Commons-TMC (Texas Medical Center)
Predictors of Contralateral Breast Cancer in BRCA Negative Women
Simmons, A. (2012) · Digital Commons-TMC (Texas Medical Center)
Gynecologic Considerations for Women with Breast Cancer
Robinson, W. R., & Ali, K. F. (2014) · Springer eBooks · doi:10.1007/978-81-322-0843-3_18
Critique of “Evidence-Based Surgical Hypothesis: The case against BRCA1 and 2 testing”
Nussbaum, R. L. (2012) · Surgery · doi:10.1016/j.surg.2011.12.030
Gutowski, M. (2013)
Risk-Reducing Surgery for Breast Cancer Patients with BRCA Mutations
Kim, E., Kim, S., & Noh, D. (2016) · Springer eBooks · doi:10.1007/978-4-431-55552-0_1
MODERN VIEWS ON BILATERAL BREAST CANCER
Fesik, Y. A., Krakhmal, N. V., Zavyalova, M. V., Михайлович, П. В., Slonimskaya, Y. M., & Vtorushin, S. V. (2014) · Bulletin of Siberian Medicine · doi:10.20538/1682-0363-2014-5-160-168
Follow Up of Patients with Germline Mutations in High Risk Predisposition Genes
Kemp, Z. (2016) · Springer eBooks · doi:10.1007/978-3-319-41858-2_5
Medical Management of Breast Cancer in BRCA Mutation Carriers
Bayraktar, S., & Arun, B. (2017) · Springer eBooks · doi:10.1007/978-3-319-59198-8_8
Risk-Reducing Surgery for BRCA1/2 Genetic Mutation Carriers
O’Donoghue, C., Orcutt, S. T., Pal, T., & Laronga, C. (2017) · Springer eBooks · doi:10.1007/978-3-319-59198-8_4
Surgical Management of Breast Cancer in BRCA Mutation Carriers
Cronin, P. A., & Cody, H. S. (2017) · Springer eBooks · doi:10.1007/978-3-319-59198-8_7
Metadata
- Authors
- Metcalfe, K., Gershman, S., Lynch, H. T., Ghadirian, P., Tung, N., Kim-Sing, C., Olopade, O. I., Domchek, S., McLennan, J., Eisen, A., Foulkes, W. D., Rosen, B., Sun, P., & Narod, S. A.
- Affiliations
- University of Toronto (CA)
- Creighton University (US)
- Centre Hospitalier de l’Université de Montréal (CA)
- Beth Israel Deaconess Medical Center (US)
- University of Chicago (US)
- University of Pennsylvania (US)
- University of California, San Francisco (US)
- Sunnybrook Health Science Centre (CA)
- McGill University (CA)
- University Health Network (CA)
- Women’s College Hospital Research and Innovation Institute (CA)
- Corresponding author
- Narod, S A
- Venue
- British Journal of Cancer
- Published
- 2011-04
- Volume
- 104
- Issue
- 9
- Pages
- 1384-1392
- ISSN
- 0007-0920 (ISSN-L)
- 1532-1827
- PMC
- PMC3101934
- OpenAlex
- W2002561481
- Cited by
- 232
- References
- 15
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 12 · 2023: 11 · 2022: 15 · 2021: 21 · 2020: 31 · 2019: 13 · 2018: 9 · 2017: 12 · 2016: 17 · 2015: 20 · 2014: 18 · 2013: 21 · 2012: 16
- FWCI
- 11.97
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-sa
- www.springer.com/tdm (unspecified)
- Locations
- British Journal of Cancer (publishedVersion, cc-by-nc-sa)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › BRCA gene mutations in cancer
- Health Sciences › Medicine › Epidemiology › Multiple and Secondary Primary Cancers
- Health Sciences › Medicine › Pathology and Forensic Medicine › Breast Lesions and Carcinomas
- Keywords
- contralateral breast cancer, BRCA1 mutation, BRCA2 mutation, hereditary breast cancer, oophorectomy, age at diagnosis, family history (medicine), first-degree relatives, early-onset breast cancer, risk factors, young women
- MeSH terms
- Adult, Age Factors, Aged, Breast Neoplasms, Female, Heterozygote, Humans, Middle Aged, Mutation, Ovariectomy, Predictive Value of Tests, Risk Factors, Cohort Studies, Odds Ratio, Survival Analysis, Neoplasms, Second Primary, Risk Assessment, Genes, BRCA1, Genetic Predisposition to Disease, Genes, BRCA2
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