ICARE Newsletter Winter 2014

Ask the Expert

The following question was addressed by Dr. Laronga who is a breast surgeon based at the Moffitt Cancer Center:

Q. What are the risks of breast cancer after ovarian cancer in BRCA carriers? What risk management options are recommended?

A. BRCA carriers remain at a higher risk of breast cancer, even after having ovarian cancer; yet there is little information as to how high this risk might be. Recently, a study of women with ovarian cancer and a BRCA mutation who were followed up for an average of almost six years showed that ~10% went on to develop breast cancer.1Thus, most women (i.e., ~90% or higher) did not develop breast cancer, even when looking at 10-year survival rates. The risk of breast cancer in women with ovarian cancer was actually lower than in BRCA carriers without ovarian cancer. Study authors suggest that non-surgical management of breast cancer risk may be appropriate for these women. At Moffitt, ovarian cancer survivors with BRCA mutations are generally offered breast cancer screening recommended by the National Comprehensive Cancer Network (NCCN).2 In addition, these women are offered consultation with a breast surgical oncologist to discuss prophylactic mastectomy after they are cancer-free five years out from their initial ovarian cancer diagnosis.

1. Domchek SM et al. Risk of metachronous breast cancer after BRCA mutation-associated ovarian cancer. Cancer. 2013 Apr 1;119(7):1344-8. PubMed PMID:23165893. 2. NCCN guidelines, 2013 Genetic/Familial High-risk Assessment: Breast and Ovarian. in NCCN Practice Guidelines V.4.2013 edn Vol. 2013 (National Comprehensive Cancer Network, Fort Washington, PA, 2013).