Usage Patterns of Surveillance, Chemoprevention and Risk-Reducing Surgery in Korean BRCA Mutation Carriers: 5 Years of Experience at a Single Institution

Do Hoon Koo; Il Yong Chung; Eunyoung Kang; Sang Ah Han; Sung-Won Kim

doi:10.4048/jbc.2011.14.S.S17

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Koo, Chung, Kang, Han, and Kim: Usage Patterns of Surveillance, Chemoprevention and Risk-Reducing Surgery in Korean BRCA Mutation Carriers: 5 Years of Experience at a Single Institution

Original Article

Journal of Breast Cancer

Journal of Breast Cancer 2011; 14(Suppl 1): S17-S23.

Published online: 28 February 2011

DOI: https://doi.org/10.4048/jbc.2011.14.S.S17

Usage Patterns of Surveillance, Chemoprevention and Risk-Reducing Surgery in Korean BRCA Mutation Carriers: 5 Years of Experience at a Single Institution

Do Hoon Koo, Il Yong Chung^1,², Eunyoung Kang^1,², Sang Ah Han³, Sung-Won Kim^1,²

Department of Surgery, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea.

¹Breast Care Center, Seoul National University Bundang Hospital, Seongnam, Korea.

²Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

³Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.

Correspondence: brcakorea@gmail.com

Received 4 August 2010 Accepted 25 January 2011

Abstract

Purpose

Options for BRCA mutation carriers include close surveillance, chemoprevention, and risk-reducing surgery (RRS) for breast and ovarian cancer. However, chemoprevention and RRS for cancer prevention are not widely performed in Korea. The aim of this study was to investigate the usage patterns of surveillance, chemoprevention and RRS of breast and ovary in Korean BRCA mutation carriers.

Methods

We retrospectively reviewed the medical record of 67 women who were diagnosed with BRCA1 or BRCA2 mutation between January 2005 and May 2009 at Seoul National University Bundang Hospital.

Results

Mean age was 46 years old (range, 27-73 years), and median follow-up period was 10 months. The numbers of affected and unaffected carriers were 50 (74.6%) and 17 (25.4%). In 47 women affected with breast cancer excluding 3 cases of concurrent breast/ovarian cancers, 42 (89.4%) have received intensive surveillance only, 2 (4.3%) have taken tamoxifen for chemoprevention, and 3 (6.4%) have undergone contralateral prophylactic mastectomies to prevent breast cancer. For ovarian cancer prevention, risk reducing salpingo-oophorectomy was performed in 11 (24.4%) of 45 affected carriers excluding 5 patients who had bilateral salphingo-oophorectomy previously. In 17 unaffected carriers, chemoprevention and RRS were not performed. Only 4 (23.5%) of these unaffected carriers have chosen surveillance for breast or ovarian cancer. Old age and no family history are related to the poor compliance (no follow-up) of the carriers only in the univariate analysis but not in the multivariate analysis.

Conclusion

Most of the Korean affected BRCA mutation carriers in our study chose intensive surveillance rather than chemoprevention or RRS. We should take special effort to follow and educate unaffected carriers, especially for those with old age or no family history.

Keywords: BRCA1/2, Chemoprevention, Prophylactic Surgery, Surveillance

Figures and Tables

Figure 1

Diagram for usage pattern of breast cancer surveillance and prophylactic interventions from 47 affected carriers.

Figure 2

Diagram for usage pattern of breast/ovarian cancer surveillance and prophylactic interventions from 17 unaffected BRCA mutation carriers.

Table 1

Clinicopathologic characteristics of 56 cases of breast cancer adding 7 cases of bilateral breast cancers in 49 affected carriers who excluded 1 case of BRCA1/2 carrier from 50 affected carriers

DCIS=ductal carcinoma in situ; ER=estrogen receptor; PR=progesterone receptor; IHC=immunohistochemistry; FISH=Fluorescence in situ hybridization.

^*Adding 2 cases of bilateral breast cancer to 23 cases of unilateral; ^†Adding 5 cases of bilateral breast cancer to 26 cases of unilateral; ^‡Values represent mean age (range).

Table 2

Types and rates of breast cancer surveillance and prophylactic interventions in 47 breast cancer patients excluding 3 cases of concurrent breast/ovarian cancers from 50 affected carriers

MRI=magnetic resonance imaging; ER=estrogen receptor; PR=progesterone receptor; CRRM=contralateral risk-reducing mastectomy.

^*Excluding 3 cases of bilateral mastectomy; ^†Excluding 7 cases of bilateral breast cancer diagnosed before counseling.

Table 3

Surveillance and prophylactic interventions of breast and ovarian cancers in unaffected BRCA mutation carriers

MRI=magnetic resonance imaging; BRRM=bilateral risk-reducing mastectomy; TVS=transvaginal sonography; RRSO=risk-reducing salphingo-oophorectomy.

Table 4

Analysis of related factors between Follow-up and No follow-up group

OR=odds ratio; CI=confidence interval.

^*Values represent mean±SD; ^†Excluding 1 case of BRCA1/2 carrier.

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