Risk reducing mastectomy: outcomes in 10 European Centres

Gareth Evans ^1*, Andrew Baildam ², Anne Brain ², Elaine Anderson ³, Andrew Shenton ⁴, Hans F.A. Vasen ⁵, Diana Eccles ⁶, Anneke m Lucassen ⁷, Gabriella Pichert ⁸, Hisham Hamed ⁸, Pål Møller ⁹, Lovise Mahle ⁹, Patrick Morrison ¹⁰, Dominique Stoppat-Lyonnet ¹¹, Helen Gregory ¹², Elizabeth Smyth ¹², Dieter Niederacher ¹³, Christine Nestle-Krämling ¹³, Joyce Campbell ³, Fiona Lalloo ¹⁴ and Anthony Howell ¹⁵

¹ St Mary's Manchester, United Kingdom
² Wythenshawe Hospital, United Kingdom
³ South East Scotland Breast Screening Programme, United Kingdom
⁴ St Mary's Hospital, United Kingdom
⁵ Netherlands Foundation for the Detection of Hereditary Tumours, Netherlands
⁶ Southampton University, United Kingdom
⁷ University of Southampton, United Kingdom
⁸ Guys Hospital, United Kingdom
⁹ Norwegian Radium Hospital, Norway
¹⁰ Belfast City Hospital, United Kingdom
¹¹ Institu Curie, France
¹² University of Aberdeen, United Kingdom
¹³ University Medical Clinic Düsseldorf, Germany
¹⁴ St Marys Hospital, Manchester, United Kingdom
¹⁵ Christie Hospital, United Kingdom

^* To whom correspondence should be addressed. E-mail: gareth.evans{at}cmmc.nhs.uk.

Accepted 16 October 2008

Abstract

Background: Increasingly women at high risk of breast cancer are opting for risk reducing surgery. The aim of this study was to assess the effectiveness of this approach in women at high risk in both carriers and non-carriers of BRCA1/2.

Methods: Data from 10 European centres that offer a genetic counselling and screening service to women at risk have been obtained prospectively from 1995. Breast cancer risks were estimated from life tables and a control group of women at risk who did not undergo surgery.

Results: The combined centres have data on 550 women who have undergone risk reducing mastectomy with greater than 3334 women years of follow up. Operations were carried out on women with lifetime risks of 25-80%, with an average expected incidence rate of 1% per year. No breast cancers have occurred in this cohort in the "at risk" unaffected breast, whereas >34 would have been expected. A high rate (2-3.6%) of occult disease was identified in the at risk breast at the time of surgery.

Interpretation: We conclude that risk reducing surgery is highly effective.