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Is hormone replacement therapy (HRT) following risk-reducing salpingo-oophorectomy (RRSO) in BRCA1 (B1)- and BRCA2 (B2)-mutation carriers associated with an increased risk of breast cancer?
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2011
Year
Surgical OncologyBreast OncologyGynecologyPathologyOvarian CancerOncologyClinical TrialsB2 MutationPublic HealthRadiation OncologyCancer ResearchMenopause Hormone TherapyCancer PreventionEndocrine-related CancerHormone Replacement Therapy-Mutation CarriersCancer EpidemiologyCancer RiskBreast CancerMenopauseMedicineProse ConsortiumWomen's Health
1501 Background: Women with B1 and B2 mutation are at increased risk of breast and ovarian cancer, which is significantly reduced by RRSO. The reduction in breast cancer risk may be greatest prior to age 40; however, such early menopause can lead to significant menopausal symptoms and other health problems. Two small prior studies have suggested that HRT following RRSO does not increase the risk of breast cancer, but further data are needed. Methods: From the PROSE consortium, 1,299 B1 (n= 795) and B2 (n=504) mutation carriers who underwent RRSO following study ascertainment and in whom HRT status was known were followed prospectively. Data were collected on HRT use and subsequent breast cancer diagnosis. Results: In both B1 and B2 mutation carriers with ever use of HRT following RRSO, no increased risk of breast cancer was observed compared to those with no RRSO. In B1 carriers, HRT use both with (HR 0.52) and without (HR 0.29) RRSO was associated with a decreased risk of breast cancer. No increased risk of breast cancer was seen with either combination HRT or estrogen-only HRT. Conclusions: In this prospective study of 1,299 B1 and B2 mutation carriers, HRT following RRSO was not associated with an increased risk of breast cancer. HRT use Never Ever Never Post-RRSO RRSO: No No Yes Yes Controls Mean age at RRSO – – 45.0 (20.5-79.0) 40.8 (29.4-63.4) Mean age in controls 34.4 (18.1-90.4) 45.6 (18.7-90.0) – – Mean follow-up to BC 4.8 (0.5-17.6) 7.4 (0.9-20.6) 2.7 (0.5-6.0) 4.9 (0.8-20.2) Mean follow-up to censoring 5.1 (0.5-27.8) 5.9 (0.5-27.7) 3.6 (0.5-18.8) 5.4 (0.6-27.4) Total sample (N) 867 111 177 144 BC in follow-up 194 (22%) 19 (17%) 22 (12%) 20 (14%) HR (95% CI) [1] 0.51 (0.32-0.80) 0.62 (0.38-1.01) 0.46 (0.28-0.76) BRCA1 (N) 520 55 115 105 BC in follow-up 118 (23%) 5 (9%) 16 (14%) 17 (16%) HR (95% CI) [1] 0.29 (0.13-0.69) 0.63 (0.35-1.14) 0.52 (0.30-0.92) BRCA2 (N) 347 56 62 39 BC in follow-up 76 (22%) 14 (25%) 6 (10%) 3 (8%) HR (95% CI) [1] 0.73 (0.42-1.27) 0.52 (0.21-1.27) 0.24 (0.05-1.03)