Risk-Reducing Mastectomy vs. Surveillance for Women With BRCA Mutation and History of Ovarian Cancer
Many women who carry the BRCA gene may consider undergoing mastectomy or removal of fallopian tubes and ovaries as preventive measures. New research led by Charlotte Gamble, MD, MPH, and Rachel Greenup, MD, of Duke University Medical Center, suggests the procedure may not be cost-effective for all patients.
In an article published in the Annals of Surgical Oncology, the authors designed a statistical model comparing risk-reducing mastectomy with breast cancer screening, including mammography and magnetic resonance imaging.
Results of the study showed that for women diagnosed at any age with BRCA1 and BRCA2 mutations and within the first 5 years after ovarian cancer diagnosis, risk-reducing mastectomy showed a negligible gain in survival and thus was not cost-effective. Gain in survival months was also negligible for women aged 60 or older, regardless of the time since diagnosis. The only group in which prophylactic mastectomy was found to be cost-effective, with a survival benefit of 2 to 5 months, consisted of women diagnosed at age 40 to 50 with BRCA1 and BRCA2 mutations and at least 5 years after an ovarian cancer diagnosis.
“Within the first 5 years, nobody benefited from risk-reducing mastectomy,” commented Dr. Gamble in a press release. “And after that threshold, survival gains were seen mostly in the youngest, healthiest ovarian cancer patients.”