Risk reducing mastectomy: outcomes in 10 European centres
- D G R Evans1,2,
- A D Baildam3,
- E Anderson4,
- A Brain3,
- A Shenton1,
- H F A Vasen5,
- D Eccles6,
- A Lucassen6,
- G Pichert7,
- H Hamed7,
- P Moller8,
- L Maehle8,
- P J Morrison9,
- D Stoppat-Lyonnet10,
- H Gregory11,
- E Smyth11,
- D Niederacher12,
- C Nestle-Krämling12,
- J Campbell4,
- P Hopwood13,
- F Lalloo1,
- A Howell2
- 1Medical Genetics Research Group and Regional Genetics Service, University of Manchester and Central Manchester and Manchester Children’s University Hospitals NHS Trust, St Mary’s Hospital, Manchester, UK
- 2Genesis Prevention Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, UK
- 3Departments of Breast and Plastic Surgery, Wythenshawe Hospital, Manchester, UK
- 4South East Scotland Breast Screening Programme Ardmillan House, 42 Ardmillan Terrace, Edinburgh EH11 2JL
- 5Foundation for the Detection of Hereditary Tumours, Leiden, Netherlands
- 6CRC Genetic Epidemiology Research Group, Wessex Regional Genetics Service, Southampton, UK
- 7Division of Medical and Molecular Genetics and Surgery, Guy’s Hospital, London, UK
- 8Section for Inherited Cancer, Department of Medical Genetics, The National Hospital, Oslo, Norway
- 9Department of Medical Genetics, Belfast HSC Trust, Belfast, UK
- 10Unite de Genetique Oncologique, Institut Curie, Paris, France
- 11Department of Medical Genetics and Surgery, University of Aberdeen, Foresterhill, Aberdeen, UK
- 12Department Obstetrics and Gynecology, University Medical Clinic Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
- 13Psycho-Oncology, The Christie NHS Trust, Withington, Manchester, UK
- Dr D G R Evans, Central Manchester and Manchester Children’s University Hospitals NHS Trust, St Mary’s Hospital, Manchester, M13 0JH, UK; gareth.evans{at}cmmc.nhs.uk
- Received 30 July 2008
- Revised 11 October 2008
- Accepted 16 October 2008
- Published Online First 7 November 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 were 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.
Footnotes
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Competing interests: None declared.
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Patient consent: Not required.
