Cited by 973BRCA gene mutations in cancerWomen's cancer prevention and managementBreast Lesions and Carcinomas

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Breast Cancer after Prophylactic Bilateral Mastectomy in Women with a BRCA1 or BRCA2 Mutation

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Meijers-Heijboer, Hanne, van Geel, Bert, van Putten, Wim L.J., Henzen-Logmans, Sonja C., Seynaeve, Caroline, Menke-Pluymers, Marian B.E., Bartels, Carina C.M., Verhoog, Leon C., van den Ouweland, Ans M.W., Niermeijer, Martinus F., Brekelmans, Cecile T.M., Klijn, Jan G.M.·2001·New England Journal of Medicine

DOI 10.1056/nejm200107193450301

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Abstract

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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Approaching the Dilemma Between Prophylactic Bilateral Mastectomy or Oophorectomy for Breast and Ovarian Cancer Prevention in Carriers of BRCA1 or BRCA2 Mutations
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Breast Cancer Risk – Genes, Environment and Clinics
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“By contrast, while preventive mastectomy is seen by professionals as highly efficient in limiting cancer risk (Meijers-Heijboer et al. 2001; Hartmann et al. 2001), opinions on its use vary.”
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The course of distress in women at increased risk of breast and ovarian cancer due to an (identified) genetic susceptibility who opt for prophylactic mastectomy and/or salpingo-oophorectomy
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MethodResult
Prophylactic irradiation to the contralateral breast for BRCA mutation carriers with early-stage breast cancer
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“003).(16) In another study of 26 BRCA mutation carriers, no cancer occurred after PM with a median follow-up of 13.”

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)
ORCID: Meijers-Heijboer, Hanne
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
DOI: 10.1056/nejm200107193450301
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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Breast Cancer after Prophylactic Bilateral Mastectomy in Women with a BRCA1 or BRCA2 Mutation

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