Data from Effectiveness of Prophylactic Surgeries in <i>BRCA1</i> or <i>BRCA2</i> Mutation Carriers: A Meta-analysis and Systematic Review

Abstract

<div>Abstract<p><b>Purpose:</b> To systematically investigate the effectiveness of prophylactic surgeries (PS) implemented in women carrying <i>BRCA1/2</i> mutations.</p><p><b>Experimental Design:</b> The PubMed database was searched till August 2014 and 15 studies met the inclusion criteria. Fixed- or random-effects models were conducted according to study heterogeneity. We calculated the pooled relative risks (RR) for cancer risk or mortality along with 95% confidence intervals (CI).</p><p><b>Results:</b> Prophylactic bilateral salpingo-oophorectomy (PBSO) and bilateral prophylactic mastectomy (BPM) were both associated with a decreased breast cancer risk in <i>BRCA1/2</i> mutation carriers (RR, 0.552; 95% CI, 0.448–0.682; RR, 0.114; 95% CI, 0.041–0.317, respectively). Similar findings were observed in <i>BRCA1</i> and <i>BRCA2</i> mutation carriers separately. Moreover, contralateral prophylactic mastectomy (CPM) significantly decreased contralateral breast cancer incidence in <i>BRCA1/2</i> mutation carriers (RR, 0.072; 95% CI, 0.035–0.148). Of note, PBSO was associated with significantly lower all-cause mortality in BRCA1/2 mutation carriers without breast cancer (HR, 0.349; 95% CI, 0.190–0.639) and those with breast cancer (HR, 0.432; 95% CI, 0.318–0.588). In addition, all-cause mortality was significantly lower for patients with CPM than those without (HR, 0.512; 95% CI, 0.368–0.714). However, BPM was not significantly associated with reduced all-cause mortality. Data were insufficient to obtain separate estimates of survival benefit with PS in <i>BRCA1</i> or <i>BRCA2</i> mutation carriers.</p><p><b>Conclusions:</b> <i>BRCA1/2</i> mutation carriers who have been treated with PS have a substantially reduced breast cancer incidence and mortality. <i>Clin Cancer Res; 22(15); 3971–81. ©2016 AACR</i>.</p></div>