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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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ResultHereditary Breast and Ovarian Cancer Syndrome
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Modified Radical Mastectomy and Simple Mastectomy
Bland, K. I., Chang, H. R., & Copeland, E. M. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-35955-9.00031-3 · Cited by 13
Manoukian, S., Alfieri, S., Bianchi, E., Peissel, B., Azzollini, J., & Borreani, C. (2019) · Psycho-Oncology · doi:10.1002/pon.5166 · Cited by 13
“Moreover, as concerns the risk for OC, intensive surveillance has failed to demonstrate a significant improvement in both early cancer detection and survival in high‐risk women.(7,8) Conversely, risk‐reducing surgery has been shown to effectively prevent the development of both BC and OC.”
BackgroundTynan, M., Peshkin, B. N., Isaacs, C. J., Willey, S. C., Valdimarsdottir, H. B., Nusbaum, R. H., Hooker, G. W., O’Neill, S. C., Jandorf, L. H., Kelly, S. P., et al. (2020) · Breast Cancer Research and Treatment · doi:10.1007/s10549-019-05515-2 · Cited by 13
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“Bilateral mastectomy has been shown to decrease the risk of breast cancer by approximately 90% [15,16].”
BackgroundThe Prevention of Hereditary Breast Cancer
Rodriquez, E., & Domchek, S. M. (2007) · Seminars in Oncology · doi:10.1053/j.seminoncol.2007.07.006 · Cited by 13
Oseni, T. O., & Jatoi, I. (2008) · Surgical Clinics of North America · doi:10.1016/j.suc.2008.04.010 · Cited by 13
Genetic testing for hereditary cancer: Challenges to ethical care in rural and remote communities
d’Agincourt-Canning, L. (2004) · HEC Forum · doi:10.1007/s10730-005-2233-z · Cited by 15
Recent developments: Breast cancer
Morrow, M. (2002) · BMJ · doi:10.1136/bmj.324.7334.410 · Cited by 13
Waldman, S. A., & Terzic, A. (2009) · Clinical and Translational Science · doi:10.1111/j.1752-8062.2008.00067.x · Cited by 12
How to manage BRCA mutation carriers?
Sabiani, L., Barrou, J., Mathis, J., Eisinger, F., Bannier, M., Lambaudie, É., & Houvenaeghel, G. F. (2020) · Hormone Molecular Biology and Clinical Investigation · doi:10.1515/hmbci-2019-0065 · Cited by 12
Lakhani, N., Weir, J., Allford, A., Kai, J., & Barwell, J. (2013) · Journal of Palliative Medicine · doi:10.1089/jpm.2012.0583 · Cited by 12
Recognizing BRCA gene mutation risk subsequent to breast cancer diagnosis in southwestern Ontario.
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Cost effectiveness of bilateral risk-reducing mastectomy and salpingo-oophorectomy
Schrauder, M. G., Brunel-Geuder, L., Häberle, L., Wunderle, M., Hoyer, J., Csorba, R., Reis, A., Schulz‐Wendtland, R., Beckmann, M. W., & Lux, M. P. (2019) · European journal of medical research · doi:10.1186/s40001-019-0391-8 · Cited by 12
The Role of Surgery in Cancer Prevention
Jatoi, I., Benson, J. R., Liau, S., Chen, Y., Cisco, R. M., Norton, J. A., Moley, J. F., Khalifeh, K. W., & Choti, M. A. (2010) · Current Problems in Surgery · doi:10.1067/j.cpsurg.2010.06.002 · Cited by 12
Hereditary Breast and Ovarian Cancer: What the Primary Care Physician Should Know
Khoury-Collado, F., & Bombard, A. (2004) · Obstetrical and Gynecological Survey · doi:10.1097/00006254-200407000-00023 · Cited by 16
Genetic Testing for Cancer Susceptibility
Hieken, T. J. (2006) · Springer eBooks · doi:10.1007/0-387-21701-0_79 · Cited by 12
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Breast Cancer Risk Assessment and Risk Reduction
Newman, L. A., & Vogel, V. G. (2007) · Surgical Clinics of North America · doi:10.1016/j.suc.2007.01.010 · Cited by 11
“Similarly, Meijers-Heijboer and colleagues [42] reported outcome for 76 BRCA-mutation carriers followed prospectively after having undergone prophylactic mastectomy, and found no tumors developing with an average follow-up of nearly 3 years.”
Press, N. A., Reynolds, S., Pinsky, L. E., Murthy, V. S., Leo, M. C., & Burke, W. (2005) · Social Science & Medicine · doi:10.1016/j.socscimed.2005.01.012 · Cited by 11
Kroiss, R., Winkler, V., Kalteis, K., Bikas, D., Rudas, M., Tea, M., Fuerhauser, C., Muhr, D., Cerny, H., Glueck, S., et al. (2008) · Journal of Cancer Research and Clinical Oncology · doi:10.1007/s00432-008-0383-5 · Cited by 11
Cancer Previval and the Theatrical Fact
Nye, C. (2012) · TDR/The Drama Review · doi:10.1162/dram_a_00217 · Cited by 11
“…and surgeons to discuss surgical options, such as a preventive mastectomy and oophorectomy (surgical removal of ovaries), which have been found to significantly reduce BRCA gene mutation carriers’ risk for developing cancer (Hartmann et al. 1999; Rebbeck et al. 1999; Meijers-Heijboer et al. 2001).”
BackgroundSie, A. S., Spruijt, L., van Zelst–Stams, W. A. G., Mensenkamp, A. R., Ligtenberg, M. J. L., Brunner, H. G., Prins, J. B., & Hoogerbrugge, N. (2012) · BMC Women s Health · doi:10.1186/1472-6874-12-12 · Cited by 11
Hereditary Breast Cancer and Handling of Patients at Risk
Eerola, H., Aittomäki, K., Asko-Seljavaara, S., Nevanlinna, H., & von Smitten, K. V. (2002) · Scandinavian Journal of Surgery · doi:10.1177/145749690209100312 · Cited by 10
“In BRCA mutation carriers, RRM has been shown to reduce the risk of breast cancer already after three years follow-up (67).”
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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