ICARE Newsletter Summer 2018

Ask the Expert

The following question was addressed by Ronald D. Alvarez, MD, MBA who is Professor, Chairman, and Clinical Service Chief of the Department of Obstetrics and Gynecology at Vanderbilt University Medical Center in Nashville, Tennessee. Dr. Alvarez has been the recipient of several National Cancer Institute (NCI) and other industry funded grants in support of his research in gene therapeutics for ovarian cancer. He has served on the editorial board of Gynecologic Oncology and currently serves as Director of the Gynecologic Oncology Division for the American Board of Obstetrics and Gynecology.

Q. After an ovarian cancer diagnosis, should women with a BRCA mutation consider a risk-reducing mastectomy?

A. Among women with ovarian cancer who are found to have a BRCA1 or BRCA2 mutation, there is a lack of clear guidance as to when and in whom to consider risk-reducing mastectomy. In a study based on BRCA carriers (which included ICARE participants), 4% of these women developed breast cancer ten years following the ovarian cancer diagnosis. However, benefits of mastectomy (as well as breast MRI for early breast cancer detection) were primarily seen among women who had survived 10 years following their ovarian cancer diagnosis (without any disease recurrence) or had early stage (stage I or II) ovarian cancer. Consequently, risk-reducing mastectomy or breast MRI may be considered among BRCA carriers with ovarian cancer without a personal history of breast cancer and no evidence for recurrence for 10 years, as well as among those with early stage disease.

McGee J, et al. Gynecol Oncol. 2017 May. PMID: 28314588.

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