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Sunday, August 20, 2017

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Prophylactic Mastectomy After BRCA+ Stage 2 Ovarian Ca: over 50? – No, under 50? – Consider after 5 yrs

A recent editorial in Annals of Surgical Oncology refines breast management decisions for BRCA+ patients who have been treated for ovarian cancer. Judy Boughey and colleagues from Mayo Clinic Rochester (Hendrickson, et al) reviewed a recent report from researchers at Duke University (Gamble, et al) including Shelley Hwang which recommends considering risk-reducing mastectomy (RRM) only after a 5-year disease free interval after treatment for ovarian cancer.

Judy Boughey

“Gamble et al. have published the first study that helps us to evaluate the survival benefit and cost-effectiveness of RRM among women with BRCA1 and BRCA2 mutations following stage II–IV ovarian cancer.”

“Among women older than age 60 years who are diagnosed with ovarian cancer, the incremental cost-effectiveness ratio (ICER) exceeds a generally accepted willingness to pay threshold of $100,000–$200,000 per year of life saved (YLS) in most scenarios and the benefit of RRM was negligible. The added benefit of RRM in terms of survival gain in months was greatest in women aged 40 years…”

Shelley Hwang

 

 

 

 

 

 

 

 

 

 

 

The current (Mayo Clinic Rochester) recommendations for managing these patients are summarized above.

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