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Purpose <p>Knowledge of the uptake and breast and ovarian cancer-preventive and survival effects of bilateral risk-reducing mastectomy (BRRM) and salpingo-oophorectomy (RR-BSO) in female <i>BRCA1/2</i> carriers is essential for optimized decision-making. This study aimed to examine time trends in the number of registered unaffected <i>BRCA1/2</i> carriers, BRRM and RR-BSO uptake, and oncological effects of risk-reducing surgeries in a nationwide Danish cohort with matched controls.</p> Methods <p>We included 3067 female <i>BRCA1/2</i> carriers registered in the Hereditary Breast and Ovarian Cancer Registry and 30,652 age-matched controls between 2000 and 2022. Data were retrieved from national health registries. Uptake and oncological effects of risk-reducing surgeries were assessed using cumulative incidences and Cox proportional hazards models with 95% confidence intervals (CI).</p> Results <p>Annual numbers of registered unaffected <i>BRCA1/2</i> carriers, BRRM, and RR-BSO increased over time. BRRM and RR-BSO uptake 10&#xa0;years after genetic test varied with the age at genetic test and parity. BRRM reduced the hazard rate of breast cancer by 94% [hazard ratio (HR) 0.06, CI 0.01–0.25]. The same pattern was not found for RR-BSO (HR = 1.31, CI 0.90–1.91). Compared to controls, <i>BRCA1/2</i> carriers had an increased hazard rate for breast cancer before BRRM (HR 7.49, CI 5.81–9.42).</p> Conclusion <p>BRRM’s large protective effect against breast cancer in <i>BRCA1/2</i> carriers was confirmed, in contrast to that of RR-BSO. There were tendencies toward a reduction in overall mortality rates after BRRM, and compared with controls, we saw tendencies toward higher mortality rates before BRRM.</p>

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Time trends, uptake, and oncological effects of risk-reducing surgeries in 3067 Danish BRCA1/2 carriers: a population-based study with matched controls

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月20日

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  • Cecilie Balslev Willert,
  • Lene Mellemkjær,
  • Anders Tolver,
  • Anne-Marie Axø Gerdes,
  • Susanne Rosthøj,
  • Karin Wadt,
  • Niels Kroman,
  • Pernille Envold Bidstrup,
  • Lisbet Rosenkrantz Hölmich

摘要

Purpose

Knowledge of the uptake and breast and ovarian cancer-preventive and survival effects of bilateral risk-reducing mastectomy (BRRM) and salpingo-oophorectomy (RR-BSO) in female BRCA1/2 carriers is essential for optimized decision-making. This study aimed to examine time trends in the number of registered unaffected BRCA1/2 carriers, BRRM and RR-BSO uptake, and oncological effects of risk-reducing surgeries in a nationwide Danish cohort with matched controls.

Methods

We included 3067 female BRCA1/2 carriers registered in the Hereditary Breast and Ovarian Cancer Registry and 30,652 age-matched controls between 2000 and 2022. Data were retrieved from national health registries. Uptake and oncological effects of risk-reducing surgeries were assessed using cumulative incidences and Cox proportional hazards models with 95% confidence intervals (CI).

Results

Annual numbers of registered unaffected BRCA1/2 carriers, BRRM, and RR-BSO increased over time. BRRM and RR-BSO uptake 10 years after genetic test varied with the age at genetic test and parity. BRRM reduced the hazard rate of breast cancer by 94% [hazard ratio (HR) 0.06, CI 0.01–0.25]. The same pattern was not found for RR-BSO (HR = 1.31, CI 0.90–1.91). Compared to controls, BRCA1/2 carriers had an increased hazard rate for breast cancer before BRRM (HR 7.49, CI 5.81–9.42).

Conclusion

BRRM’s large protective effect against breast cancer in BRCA1/2 carriers was confirmed, in contrast to that of RR-BSO. There were tendencies toward a reduction in overall mortality rates after BRRM, and compared with controls, we saw tendencies toward higher mortality rates before BRRM.