Prophylactic oophorectomy in BRCA1/2 carriers

Abstract

1012 Background: Women who carry a BRCA1 or BRCA2 mutation are at increased risk for breast and ovarian cancer. Bilateral prophylactic oophorectomy (BPO) has been shown to decrease the risk of ovarian cancer by 85–96%, and the risk of breast cancer by 50%. Therefore, for mutation carriers, prophylactic oophorectomy is recommended after completion of childbearing. Recent studies have found disparate rates of BPO among BRCA1/2 carriers, ranging from 27 to 60%. We conducted a review to determine the rate of BPO use among our BRCA1/2 carrier population. Methods: Clinical charts were reviewed to evaluate the use of BPO among our population of BRCA1/2 carriers. Participants included female BRCA1/BRCA2 carriers registered at the Cancer Risk Clinic. Women with a history of ovarian cancer, therapeutic oophorectomy and metastatic breast cancer at the time of genetic testing were excluded. Results: 80 BRCA1 or BRCA2 carriers in the Cancer Risk Clinic between January 1996 and December 2003 were included. The age at genetic testing ranged from 25 to 71 years old, and 75% were older than 35 at the time of genetic testing. 69 (86%) women were Caucasian, 9 (11%) were African-American and 2 (3%) were Hispanic. 55 (69%) were BRCA1 carriers and 25 (31%) were BRCA2 carriers. All participants received genetic counseling regarding risk reduction options including surveillance, prophylactic surgeries and chemoprevention. 9 (11%) women had a BPO prior to genetic testing, based on family history alone. An additional 32 women (40%) had undergone BPO at the time of analysis. 21 (66%) of these women had a BPO within 12 months of receiving their test results. 29 (53%) of the BRCA1 carriers and 12 (48%) of the BRCA2 carriers underwent BPO. Of the 9 African-American carriers 3 (33%) had a BPO, while neither of the 2 Hispanic carriers underwent BPO. Conclusions: Over 50% of our BRCA1 and BRCA2 carriers underwent bilateral prophylactic oophorectomy due to a family history suggestive of hereditary breast and ovarian cancer or genetic testing revealing a BRCA1/2 mutation. BPO is an acceptable method of risk reduction. Extended follow-up is necessary, as one-third of women delayed their decision to have BPO over one year after test disclosure. No significant financial relationships to disclose.