BRCA1 risk-reducing surgery appears to reduce risk of developing breast cancer


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Gareth Irwin1,Gwyneth Hinds1,Lesley McFaul1,Patrick Morrison1,Ian Harley1,Stuart McIntosh2
1Belfast City Hospital,2Belfast City Hospital/Queens University Belfast

Abstract

Background

BRCA testing was introduced in Northern Ireland in 1996 and since then people have had diagnostic and predictive testing. Patients identified with a BRCA mutation are offered risk-reducing surgery to the breast and ovaries. Information on these patients was collected to identify rates of cancer in patients who had risk reducing surgery.

Method

Patients were identified on the Northern Ireland BRCA database. Treatment regimes, surgical outcomes and tumour biology were obtained from COIS, Pathology database and the patients’ notes.

Results

822 patients were identified from the database. 328(41%), with full follow-up, were found to have a BRCA1 mutation. 52% were diagnosed following predictive testing. 16 patients developed breast cancer following predictive testing. Three of these were identified through the high-risk breast cancer screening programme, 5 at risk reducing surgery and 1 several years following RRSx, 7 others opted out of follow-up. Uptake for risk reducing breast surgery peaks at 40-44 years as does risk reducing ovarian surgery. Currently there are 51 women in NI under 45 who have not yet availed of risk reducing breast surgery.

Conclusion

Risk reducing surgery appears to reduce the risk of developing breast cancer in BRCA1 patients in Northern Ireland. Increasing screening for BRCA mutations has increased the number of patients requiring risk-reducing surgery leading to resource implications for breast surgery services.