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Prophylactic Mastectomy in BRCA1 and BRCA2 Mutation Carriers: Very Low Risk for Subsequent Breast Cancer

Kaas, Reinoutje MD, PhD*; Verhoef, Senno MD, PhD; Wesseling, Jelle MD, PhD; Rookus, Matti A. PhD§; Oldenburg, Hester S. A. MD, PhD*; Peeters, Marie-Jeanne Vrancken MD, PhD*; Rutgers, Emiel J. T. MD, PhD*

doi: 10.1097/SLA.0b013e3181c3c36d
Original Articles

Aim: To examine the outcome of prophylactic mastectomy in a hospital-based series of BRCA1/2 gene mutation carriers with and without a history of breast cancer.

Patients and Methods: A center-based consecutive series of 254 BRCA1/2 gene mutation carriers that had prophylactic mastectomy after a normal surveillance round including breast-magnetic resonance imaging were identified. One hundred forty-seven asymptomatic carriers underwent bilateral mastectomy and 107 symptomatic women had contralateral mastectomy after a mean cancer free interval of 3.6 years. All removed breasts were histopathologically examined.

Results: In one asymptomatic BRCA2 carrier (0.7%) an occult small invasive breast cancer was diagnosed, while in 6 asymptomatic carriers (4.0% BRCA1 and 4.3% BRCA2) and in 5 symptomatic carriers (2.5% BRCA1 and 10.7% BRCA2) DCIS was detected at prophylactic mastectomy.

No breast cancer occurred in the asymptomatic group after a postprophylactic follow-up period of 778 women-years. In the symptomatic carriers 1 invasive breast cancer was detected after 580 follow-up years.

From age-, cohort-, and gene-specific reference data we calculated that 15 invasive first cancers in the asymptomatic carriers were prevented during follow-up.

Conclusion: One invasive breast cancer in 147 bilateral prophylactic mastectomies (0.7%) was detected, this makes a sentinel node procedure redundant and preoperative imaging vital. The prophylactic procedure is highly effective in preventing invasive breast cancer in BRCA1/2 mutation carriers. Since the remaining risk is less than 0.2%/woman-year, continued surveillance of the asymptomatic carriers is not warranted.

Bilateral or contralateral prophylactic mastecomy in 254 BRCA1/2 carriers resulted in only 1 postprophylactic incident breast cancer.

From the Departments of *Surgery, †Clinical Genetics, ‡Pathology, and §Epidemiology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan, Amsterdam.

Presented at the EBCC in Berlin 2008 as a poster and mini-oral. Abstract number in EJC suppl. 2008, 149 page 91.

Reprints: Reinoutje Kaas, MD, PhD. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.