Time trends in uptake rates of risk-reducing mastectomy in Israeli asymptomatic BRCA1 and BRCA2 mutation carriers
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CLINICAL TRIAL
Time trends in uptake rates of risk‑reducing mastectomy in Israeli asymptomatic BRCA1 and BRCA2 mutation carriers Lee Galmor1 · Rinat Bernstein‑Molho1,2 · Miri Sklair‑Levy1,3 · Dana Madoursky‑Feldman3 · Dov Zippel3 · Yael Laitman4 · Eitan Friedman1,3,4 Received: 1 September 2020 / Accepted: 23 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The rate of risk-reducing bilateral mastectomy (RRBM) among cancer-free Israeli female BRCA1/BRCA2 mutation carriers was reportedly 13% in 2010. Current RRBM rates in Israel and factors seemingly associated with opting for RRBM were reevaluated. Methods Israeli female cancer-free BRCA1/BRCA2 mutation carriers, who were followed at the high-risk clinic at Sheba Medical Center between January 2011 and April 2020 were eligible. Univariate Cox regression and log-rank test were used to study the crude association between potential predictors and performance of RRBM. Results Overall, 427 cancer-free BRCA1 (n = 218) or BRCA2 (n = 209) mutation carriers were included. Median age at genotyping was 33.6 years (interquartile range 26.8–41.8 years), median follow-up 4.4 years (range 0.1–7.6 years). Overall, 41/427 (9.6%) participants underwent RRBM, all of them within 5 years of genotyping. Being married (HR-2.57, p = 0.017) and having a first degree relative with breast cancer (BC) (HR-2.19, p = 0.017) were positively associated with RRBM, whereas any previous benign breast biopsy was negatively associated (HR-0.48, p = 0.029) with performing RRBM. Conclusions RRBM is still infrequently elected by Israeli BRCA1/BRCA2 mutation carriers, with married women with one relative with BC who have not undergone previous breast biopsy more likely to opt for RRBM. Keywords BRCA1/2 · Risk-reducing bilateral mastectomy · Rate · Associated factors
Introduction
Lee Galmor and Rinat Bernstein-Molho have equally contributed to this study. This work was performed as a part of the requirements for the MD degree from the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (L.G.). * Eitan Friedman [email protected]; [email protected] 1
Sackler School of Medicine, Tel-Aviv University, Tel‑Aviv, Israel
2
Breast Cancer Unit, Oncology Institute, Chaim Sheba Medical Center, Tel‑Hashomer, Israel
3
The Meirav High-Risk Clinic-Chaim Sheba Medical Center, Tel‑Hashomer, Israel
4
Oncogenetics Unit, Institute of Genetics, Chaim Sheba Medical Center, 52621 Tel‑Hashomer, Israel
Women harboring germline BRCA1/BRCA2 gene mutation are at a substantially high lifetime risk of developing breast cancer (BC), ranging from 45 to 88% by age 70 years [1, 2]. Moreover, BC may be diagnosed at a younger age in BRCA1/BRCA2 mutation carriers, compared with BC age at diagnosis in the general population [2, 3]. The prevalence of BRCA1/BRCA2 mutation carriers in the general, non-Jewish population has been estimated to range from 1:400 to 1:800 in historical series, with rates varying significantly among different cou
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