Hormone Therapy Safe After Prophylactic Oophorectomy in BRCA Mutation Carriers

By Will Boggs, MD

NEW YORK OCT 18, 2005 (Reuters Health) - For women who carry BRCA1 and BRCA2 mutations and undergo bilateral prophylactic oophorectomy, short-term symptomatic hormone replacement therapy (HRT) appears safe, according to a report in the October 11 online issue of the Journal of Clinical Oncology.

"While we have many unanswered questions, knowing about a BRCA1 or BRCA2 mutation, being able to choose prophylactic surgery or other preventive options, and being able to manage post-surgery menopausal symptoms appear to provide benefits that outweigh the risks that some women have concerning genetic testing," Dr. Timothy R. Rebbeck told Reuters Health.

Dr. Rebbeck from The University of Pennsylvania School of Medicine, Philadelphia, and colleagues evaluated whether the breast cancer risk reduction conferred by bilateral prophylactic oophorectomy (BPO) in BRCA1/2 mutation carriers is altered by the use of HRT after surgery.

After BPO, women were 60% less likely to develop a primary breast cancer during a median follow-up of 3.6 years, compared with similar women who did not undergo BPO, the authors report.

Women undergoing oophorectomy were also diagnosed with breast cancer at a later age (median, 45.6 years) than were non-BPO women (median, 39.3 years), the results indicate.

Women who used HRT after BPO experienced the same reduction in breast cancer risk as women who did not use HRT, the researchers note.

"Women may not need to delay or avoid the use of oophorectomy for breast or ovarian cancer risk reduction if they carry a BRCA1 or BRCA2 mutation because they are afraid of taking HRT to deal with post-surgery menopausal symptoms," Dr. Rebbeck concluded.

"We are following up on this work with additional analyses of surgical type and timing (both in terms of age and reproductive events, whether risk reduction differs by BRCA1 vs. BRCA2 mutation carriers)," Dr. Rebbeck added.

Also, "We are asking about whether specific other biomarkers are influenced by oophorectomy, HRT use and whether risk varies by type of HRT preparation (e.g., combined HRT vs. unopposed estrogen only) and duration of HRT use and other exposures."

SOURCE:

• J Clin Oncol 11 October 2005.