Prophylactic mastectomy helpful in BRCA mutation carriers

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NEW YORK (Reuters Health), Mar 3 - Prophylactic mastectomy is highly effective in preventing invasive breast cancer in BRCA1 and BRCA2 mutation carriers, Dutch researchers report in the March issue of the Annals of Surgery.

"BRCA gene mutation carriers can be confronted with the almost impossible decision to do or not to do prophylactic mastectomy as secondary prevention of breast cancer," lead author Dr. Reinoutje Kaas told Reuters Health by e-mail. "Perhaps our research can help the carriers who are uncomfortable with screening."

Dr. Kaas and colleagues at The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, studied breast tissue from 147 asymptomatic carriers (100 BRCA1, 47 BRCA2) who had bilateral mastectomy and 107 symptomatic carriers (79 BRCA1, 28 BRCA2) who had contralateral mastectomy after a mean cancer-free interval of 3.6 years.

One asymptomatic BRCA2 carrier had an occult 5 mm invasive ductal carcinoma, and another two had ductal carcinoma in situ (DCIS). Four asymptomatic BRCA1 carriers also had DCIS.

Among the symptomatic women, two BRCA1 carriers and three BRCA2 carriers had DCIS in the contralateral breast, but none had an invasive cancer.

None of the asymptomatic carriers developed breast cancer during a postprophylactic follow-up period of 778 women-years. The symptomatic carriers had only one invasive breast cancer detected during 580 women-years.

Prophylactic mastectomy "is safe and highly effective in preventing breast cancer," Dr. Kaas said. By contrast, "screening does not lower the life-long risk and is not perfect: in 4% of the asymptomatic carriers the beginning of a breast cancer was found, undetected by mammography and MRI."

By David Douglas

Ann Surg 2010;251:494-498.

Last Updated: 2010-03-02 19:38:24 -0400 (Reuters Health)

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MRI plus film-screen mammo screening works for BRCA1 carriers, February 23, 2010

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