Mastectomies and the removal of ovaries and fallopian tubes are considered preventive measures for women carrying BRCA genetic mutations linked to breast and ovarian cancer. But for women who have already had ovarian cancer, a risk-reducing mastectomy is not cost-effective and provides few survival benefits, according to researchers at Duke University Medical Center.
Current guidelines from the National Comprehensive Cancer Network and the Society of Gynecologic Oncology (SGO) recommend that all women with newly diagnosed ovarian cancer be considered for genetic testing. That’s because 10-20% of women with ovarian cancer carry BRCA gene mutations irrespective of family history, researchers said.
“There is no right or wrong answer on how to manage breast cancer risk in this unique population,” senior author of the study Rachel Greenup, MD, assistant professor of surgery at Duke University, said in a news release. “However, we hope that our findings provide guidance to women and their doctors deciding if and when prophylactic mastectomy is beneficial following ovarian cancer treatment.”
In the study titled, “Cost Effectiveness of Risk-Reducing Mastectomy versus Surveillance in BRCA Mutation Carriers with a History of Ovarian Cancer,” published in the journal Annals of Surgical Oncology, researchers evaluated the survival benefit and cost-effectiveness of preventive mastectomy compared with regular breast cancer screening (mammograms and MRI assessment) upon ovarian cancer diagnosis.
Overall, the team found that the benefit provided by risk-reducing mastectomy compared to screening was dependent on the age at which cancer was diagnosed and the time it took to perform a mastectomy.
The study found that for most women with BRCA gene mutations, preventive mastectomy within five years of diagnosis had negligible survival benefits and it was not cost-effective. For women diagnosed at the age of 60 or older, this preventive procedure also failed to provide clinical benefit.
Only women with BRCA mutations who were diagnosed with ovarian cancer between the ages of 40 and 50 and who performed a mastectomy at least five years after cancer diagnosis saw benefits from a preventive mastectomy. For these women, a risk-reducing mastectomy was associated with a survival benefit of two to five months compared to screening methods.
“Our study provides clarity on how a woman’s age and timing of a risk-reducing mastectomy after an ovarian cancer diagnosis impact the benefit of this procedure,” said Charlotte Gamble, MD, lead author of the study and resident physician at Duke University School of Medicine.
“Within the first five years, nobody benefitted from risk-reducing mastectomy and after that threshold, survival gains were seen mostly in the youngest, healthiest ovarian cancer patients,” Gamble said. “Our results emphasize that prophylactic mastectomy should be used selectively in women with both a BRCA mutation and a history of ovarian cancer,” she added.
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