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Breast Cancer after Prophylactic Bilateral Mastectomy in Women with a BRCA1 or BRCA2 Mutation
Open accessAbstract
BACKGROUND: Women with a BRCA1 or BRCA2 mutation have a high risk of breast cancer and may choose to undergo prophylactic bilateral total mastectomy. We investigated the efficacy of this procedure in such women. METHODS: We conducted a prospective study of 139 women with a pathogenic BRCA1 or BRCA2 mutation who were enrolled in a breast-cancer surveillance program at the Rotterdam Family Cancer Clinic. At the time of enrollment, none of the women had a history of breast cancer. Seventy-six of these women eventually underwent prophylactic mastectomy, and the other 63 remained under regular surveillance. The effect of mastectomy on the incidence of breast cancer was analyzed by the Cox proportional-hazards method in which mastectomy was modeled as a time-dependent covariate. RESULTS: No cases of breast cancer were observed after prophylactic mastectomy after a mean (+/-SE) follow-up of 2.9+/-1.4 years, whereas eight breast cancers developed in women under regular surveillance after a mean follow-up of 3.0+/-1.5 years (P=0.003; hazard ratio, 0; 95 percent confidence interval, 0 to 0.36). The actuarial mean five-year incidence of breast cancer among all women in the surveillance group was 17+/-7 percent. On the basis of an exponential model, the yearly incidence of breast cancer in this group was 2.5 percent. The observed number of breast cancers in the surveillance group was consistent with the expected number (ratio of observed to expected cases, 1.2; 95 percent confidence interval, 0.4 to 3.7; P=0.80). CONCLUSIONS: In women with a BRCA1 or BRCA2 mutation, prophylactic bilateral total mastectomy reduces the incidence of breast cancer at three years of follow-up.
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“Studies on PM consistently show a risk reduction of breast cancer of at least 90% [1,2]”
From Standard psychological consultations and follow up for women at increased risk of hereditary breast cancer considering prophylactic mastectomy (2009) · cites this paper as [2]
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“which has been shown to reduce the incidence of breast cancer by approximately 90% [57-59]”
From Screening, Risk Reduction Strategies, and Clinical Management of Unaffected Carriers of BRCA1 or BRCA2 Pathogenic Variants (2026) · cites this paper as [58]
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“The risk of breast cancer can be reduced by prophylactic surgery or chemoprevention.(5-9) A promising strategy to reduce the risk of breast cancer death is early diagnosis by intensive surveillance.”
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Prevention and Management of Hereditary Breast Cancer
Narod, S. A., & Offit, K. (2005) · Journal of Clinical Oncology · doi:10.1200/jco.2005.10.035 · Cited by 167
Kleinberg, D. L., Wood, T. L., Furth, P. A., & Lee, A. V. (2008) · Endocrine Reviews · doi:10.1210/er.2008-0022 · Cited by 162
“often elect to have prophylactic bilateral mastectomies, which can drastically lower the development of breast cancer (257).”
BackgroundArmstrong, K., Schwartz, J. S., Randall, T. C., Rubin, S. C., & Weber, B. (2004) · Journal of Clinical Oncology · doi:10.1200/jco.2004.06.090 · Cited by 161
“0 [43]”
Heemskerk-Gerritsen, B. A. M., Brekelmans, C. T. M., Menke-Pluymers, M. B. E., van Geel, A. N., Tilanus-Linthorst, M. M. A., Bartels, C. C. M., Tan, M., Meijers-Heijboer, H. E. J., Klijn, J. G. M., & Seynaeve, C. (2007) · Annals of Surgical Oncology · doi:10.1245/s10434-007-9449-x · Cited by 153
“33 Necrosis 1 (1) 3 (5) Capsular formation 31 (37) 20 (35) Prosthesis luxation 2 (2) 3 (5) Poor cosmetic appearance d 31 (37) 19 (34) Dog ear 16 (19) 12 (21)”
Self-citationPretest prediction of BRCA1 or BRCA2 mutation by risk counselors and the computer model BRCAPRO.
Euhus, D., Smith, K. C., Robinson, L., Stucky, A., Olopade, O., Cummings, S., Garber, J., Chittenden, A., Mills, G., Rieger, P., et al. (2002) · Journal of the National Cancer Institute · doi:10.1093/jnci/94.11.844 · Cited by 114
Ovarian cancer risk in Ashkenazi Jewish carriers of BRCA1 and BRCA2 mutations.
Satagopan, J. M., Boyd, J. A., Kauff, N. D., Robson, M. E., Scheuer, L., Narod, S. A., & Offit, K. (2002) · PubMed · Cited by 152
Cost-Effectiveness of Preventive Strategies for Women with a BRCA1 or a BRCA2 Mutation
Anderson, K. N., Jacobson, J. S., Heitjan, D. F., Zivin, J. G., Hershman, D. L., Neugut, A. I., & Grann, V. R. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-144-6-200603210-00006 · Cited by 151
“Other recent studies suggest that bilateral prophylactic mastectomy may reduce the risk for breast cancer by 90% (12, 21, 29), tamoxifen (taken for 5 years) may reduce the risk for breast cancer by 49% (25, 30), and oral contraceptives may reduce the risk for ovarian cancer by 54% (31, 32).”
Hoogerbrugge, N., Bult, P., de Widt-Levert, L. M., Beex, L. V. A. M., Kiemeney, L. A. L. M., Ligtenberg, M. J. L., Massuger, L., Boetes, C., Manders, P., & Brunner, H. G. (2002) · Journal of Clinical Oncology · doi:10.1200/jco.2003.02.137 · Cited by 149
Udagawa, T., Fernández, A., Achilles, E., Folkman, J., & D’Amato, R. J. (2002) · The FASEB Journal · doi:10.1096/fj.01-0813com · Cited by 147
“In vivo models for human tumor dormancy would also be useful in the design of therapies to treat occult cancers to prevent relapse or primary cancer, particularly in individuals who are at high risk (20, 21, 48).”
BackgroundCancer Prevention: From 1727 to Milestones of the Past 100 Years
Lippman, S. M., & Hawk, E. T. (2009) · Cancer Research · doi:10.1158/0008-5472.can-09-1750 · Cited by 151
“cohort studies demonstrated that prophylactic mastectomy in women at risk of familial breast cancer (186), including BRCA1 or BRCA2 mutation carriers (187), substantially reduced the risk of”
BackgroundEffect of genetic cancer risk assessment on surgical decisions at breast cancer diagnosis.
Weitzel, J., McCaffrey, S., Nedelcu, R., Macdonald, D., Blazer, K., & Cullinane, C. (2003) · Archives of Surgery · doi:10.1001/archsurg.138.12.1323 · Cited by 172
Evans, D. G., Lalloo, F. I., Ashcroft, L., Shenton, A., Clancy, T., Baildam, A. D., Brain, A., Hopwood, P., & Howell, A. (2009) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-09-0171 · Cited by 147
“The efficacy of surgical procedures for reducing the risk of breast and ovarian cancer is now beyond dispute (2-6).”
BackgroundThe development of interval breast malignancies in patients with BRCA mutations
Komenaka, I. K., Ditkoff, B., Joseph, K.-A. P., Russo, D., Gorroochurn, P., Ward, M., Horowitz, E., El-Tamer, M. B., & Schnabel, F. R. (2004) · Cancer · doi:10.1002/cncr.20221 · Cited by 147
“– 6 Nonetheless, in spite of the debate regarding survival benefit, widespread adoption of the published breast carcinoma screening guidelines has led to earlier detection of breast malignancies and to the detection of a larger proportion of these malignancies in a noninvasive stage.(6,7) Over the last decade, with th…”
BackgroundHether, H. J., Huang, G. C., Beck, V., Murphy, S. T., & Valente, T. W. (2008) · Journal of Health Communication · doi:10.1080/10810730802487471 · Cited by 144
“While the prevalence of these surgeries is largely unknown, some studies report that between 19% and 50% of mutation-positive women have chosen to undergo prophylactic mastectomy to manage their cancer risks (Lynch, Lynch, & Rubinstein, 2001; Meijers-Heijboer et al., 2001).”
BackgroundIllness perceptions and distress in women at increased risk of breast cancer
Rees, G., Fry, A. M., Cull, A., & Sutton, S. R. (2004) · Psychology and Health · doi:10.1080/08870440412331279764 · Cited by 142
“High risk women may be offered prophylactic bilateral mastectomy which has been found to be effective in reducing the incidence of breast cancer in BRCA1 or BRCA2 mutation carriers (Meijers-Heijboer et al., 2001).”
BackgroundAttitudes of Patients With Cancer About Personalized Medicine and Somatic Genetic Testing
Gray, S. W., Hicks-Courant, K., Lathan, C. S., Garraway, L., Park, E. R., & Weeks, J. C. (2012) · Journal of Oncology Practice · doi:10.1200/jop.2012.000626 · Cited by 139
Risk factors and risk reduction of breast and ovarian cancer
Brekelmans, C. T. M. (2003) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/00001703-200302000-00010 · Cited by 136
Self-citationYao, K. A., Liederbach, E., Tang, R., Lei, L., Czechura, T., Sisco, M., Howard, M. A., Hulick, P. J., Winchester, D. J., Coopey, S. B., et al. (2014) · Annals of Surgical Oncology · doi:10.1245/s10434-014-3883-3 · Cited by 130
“, there were no breast cancer cases in the prophylactic mastectomy group and eight cancers in the surveillance group at 3 years of follow-up.(15) Another study of 236 BRCA1/2 carriers showed no primary breast cancers at 4.”
Psychosocial functioning in women who have undergone bilateral prophylactic mastectomy
Metcalfe, K., Esplen, M., Goel, V., & Narod, S. (2004) · Psycho-Oncology · doi:10.1002/pon.726 · Cited by 136
“For women who are at a very high risk of developing breast cancer, prophylactic mastectomy has been shown to reduce the risk of breast cancer by 80% or more (Hartmann et al., 1999, 2001; Meijers-Heijboer et al., 2001).”
BRCA1 and Breast Cancer: Molecular Mechanisms and Therapeutic Strategies
Fu, X., Tan, W., Song, Q., Pei, H., & Li, J. (2022) · Frontiers in Cell and Developmental Biology · doi:10.3389/fcell.2022.813457 · Cited by 142
“RRM can reduce the risk of developing BC in BRCA1 carriers by more than 90% (Meijers-Heijboer et al., 2001; HeemskerkGerritsen et al., 2013; Li et al., 2016) and even reduce mortality from any cause (Honold and Camus, 2018).”
BackgroundShaag, A., Walsh, T., Renbaum, P., Kirchhoff, T., Nafa, K., Shiovitz, S., Mandell, J. B., Welcsh, P. L., Lee, M. K., Ellis, N. A., et al. (2005) · Human Molecular Genetics · doi:10.1093/hmg/ddi052 · Cited by 129
Eisinger, F., Paillerets, B. B., Castaigne, D., Cottu, P. H., Lansac, J., Lefranc, J., Lesur, A., Noguès, C., Pierret, J., Puy‐Pernias, S., et al. (2006) · Pathologie Biologie · doi:10.1016/j.patbio.2006.02.002 · Cited by 150
Heemskerk‐Gerritsen, B. A. M., Menke‐Pluijmers, M. B. E., Jager, A., Tilanus‐Linthorst, M. M. A., Koppert, L. B., Obdeijn, I. M., van Deurzen, C. H. M., Collée, J. M., Seynaeve, C., & Hooning, M. J. (2013) · Annals of Oncology · doi:10.1093/annonc/mdt134 · Cited by 123
“from our institute, reported reduction of BC risk after BRRM in healthy BRCA1 or BRCA2 mutation carriers [6–10].”
BackgroundResultSelf-citationProphylactic mastectomy for the prevention of breast cancer
Lostumbo, L., Carbine, N. E., Wallace, J., Ezzo, J., & Dickersin, K. (2004) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002748.pub2 · Cited by 122
Meijers-Heijboer, H., Brekelmans, C., Menke-Pluymers, M., Seynaeve, C., Baalbergen, A., Burger, C., Crepin, E., van den Ouweland, A. V. D., van Geel, B. V., & Klijn, J. (2003) · Journal of Clinical Oncology · doi:10.1200/jco.2003.09.052 · Cited by 150
Self-citationSkytte, A., Gerdes, A., Andersen, M., Sunde, L., Brøndum‐Nielsen, K., Waldstrøm, M., Kølvraa, S., & Crüger, D. G. (2010) · Clinical Genetics · doi:10.1111/j.1399-0004.2009.01329.x · Cited by 118
Razdan, S. N., Patel, V., Jewell, S., & McCarthy, C. M. (2015) · Quality of Life Research · doi:10.1007/s11136-015-1181-6 · Cited by 119
Recognition and Management of Hereditary Breast Cancer Syndromes
Thull, D. L., & Vogel, V. G. (2004) · The Oncologist · doi:10.1634/theoncologist.9-1-13 · Cited by 118
Satisfaction with Prophylactic Mastectomy and Breast Reconstruction in Genetically Predisposed Women
Bresser, P. J. C., Seynaeve, C., Gool, A. R. V., Brekelmans, C. T. M., Meijers-Heijboer, H. E. J., van Geel, A. N., Menke‐Pluijmers, M. B. E., Duivenvoorden, H. J., Klijn, J. G. M., & Tibben, A. (2006) · Plastic & Reconstructive Surgery · doi:10.1097/01.prs.0000217383.99038.f5 · Cited by 117
“Being satisfied with result of PM/BR 113 68 (60) 13 (12) 32 (28) Would opt for PM again 112 106 (95) 5 (5) 1 (1) Would opt for BR again 112 89 (80) 12 (11) 11 (10) Feeling sufficiently informed 112 95 (85) 1 (1) 16 (14) Surgery did not meet expectations 112 35 (31) 8 (7) 69 (62) Complications‡ 113 48 (43) 2 (2) 63 (56…”
InfluentialSelf-citationBRCA1 : mechanisms of inactivation and implications for management of patients
Kennedy, R. D., Quinn, J. E., Johnston, P. G., & Harkin, D. P. (2002) · The Lancet · doi:10.1016/s0140-6736(02)11087-7 · Cited by 116
Modifiers of risk of hereditary breast cancer
Narod, S. A. (2006) · Oncogene · doi:10.1038/sj.onc.1209870 · Cited by 116
“In a cohort of 76 BRCA1 mutation carriers from Rotterdam, eight invasive cancers were detected during 318 person-years of follow-up (Meijers-Heijboer et al., 2001) – an annual incidence of 2.”
BackgroundInfluentialSardanelli, F., & Podo, F. (2006) · European Radiology · doi:10.1007/s00330-006-0389-9 · Cited by 116
Wainberg, S., & Husted, J. (2004) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.1989.13.12 · Cited by 116
“Salt Lake City, UT, USA 26 In-person interview 12 months 24 months Ages 25-39 Ages >40 — 54% (14) 71% (12) 22% (2) — 46% (12) 29% (5) 78% (7)”
InfluentialFatouros, M., Baltoyiannis, G., & Roukos, D. H. (2007) · Annals of Surgical Oncology · doi:10.1245/s10434-007-9612-4 · Cited by 115
“003) breast cancer incidence among the women who did not have the procedure.(35) Moreover, PBM reduced the risk of breast cancer by approximately 95% in women with previous or concurrent PBM and reduced the risk by approximately 90% in women with intact ovaries.”
BackgroundBreast Cancer Screening with MRI — What Are the Data for Patients at High Risk?
Liberman, L. (2004) · New England Journal of Medicine · doi:10.1056/nejme048117 · Cited by 114
Translational advances regarding hereditary breast cancer syndromes
Gage, M. M., Wattendorf, D. J., & Henry, L. R. (2012) · Journal of Surgical Oncology · doi:10.1002/jso.21856 · Cited by 118
“[27], no cases of breast cancer were seen over 3 years in 76 women who had prophylactic bilateral total mastectomies, whereas 8 of 63 women undergoing regular surveillance developed breast cancer.”
BackgroundContralateral prophylactic mastectomy
Goldflam, K., Hunt, K. K., Gershenwald, J. E., Singletary, S. E., Mirza, N. Q., Kuerer, H. M., Babiera, G. V., Ames, F. C., Ross, M. I., Feig, B. W., et al. (2004) · Cancer · doi:10.1002/cncr.20617 · Cited by 111
“More recently, studies in women with known BRCA1 and BRCA2 mutations have also demonstrated significant risk reduction with BPM.17,18 It is noteworthy that even with close observation, some of the breast carcinomas that developed in the observation group were lymph node positive, and one patient eventually died of bre…”
BackgroundArmstrong, K., Weber, B., FitzGerald, G., Hershey, J. C., Pauly, M. V., Lemaire, J., Subramanian, K., & Asch, D. A. (2003) · American Journal of Medical Genetics Part A · doi:10.1002/ajmg.a.20025 · Cited by 108
“As women in this group had an average breast cancer risk over 20%, genetic testing might have been able to identify women who would be most likely tobenefit from interventions to reducebreast cancer risk, such as prophylactic mastectomy and tamoxifen [Fisher et al., 1998; Meijers-Heijboer et al., 2001].”
Background
Metadata
- Authors
- Meijers-Heijboer, H., van Geel, B., van Putten, W. L. J., Henzen-Logmans, S. C., Seynaeve, C., Menke-Pluymers, M. B. E., Bartels, C. C. M., Verhoog, L. C., van den Ouweland, A. M. W., Niermeijer, M. F., Brekelmans, C. T. M., & Klijn, J. G. M.
- Affiliations
- Erasmus MC (NL)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2001-07-19
- Volume
- 345
- Issue
- 3
- Pages
- 159-164
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2046809735
- Cited by
- 973
- References
- 33
- Citations by year
- 2026: 15 · 2025: 14 · 2024: 14 · 2023: 18 · 2022: 18 · 2021: 24 · 2020: 23 · 2019: 30 · 2018: 21 · 2017: 37 · 2016: 42 · 2015: 28 · 2014: 34 · 2013: 29 · 2012: 42
- FWCI
- 35.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (acceptedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › BRCA gene mutations in cancer
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Pathology and Forensic Medicine › Breast Lesions and Carcinomas
- Keywords
- breast cancer, bilateral prophylactic mastectomy, BRCA1 mutation, BRCA2 mutation, hereditary breast cancer, breast cancer incidence, breast cancer surveillance, genetic susceptibility to cancer
- MeSH terms
- Adult, Breast Neoplasms, Female, Humans, Middle Aged, Mutation, Neoplasm Proteins, Prospective Studies, Transcription Factors, Mastectomy, Simple, Proportional Hazards Models, Genes, BRCA1, BRCA2 Protein
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