ROTTERDAM, The NetherlandsIn the first prospective study of
its kind, prophylactic mastectomy prevented the development of breast cancer in
women at high risk for breast cancer because of BRCA1/2 mutations, compared
with controls who did not opt for surgery.
Researchers at Erasmus University Medical Center, Rotterdam,
followed 139 women with a pathogenic BRCA1 or BRCA2 mutation who were enrolled
in a breast cancer surveillance program. None of the women had breast cancer at
the time of enrollment, and no invasive cancers were found in the women who
underwent prophylactic mastectomy (one had lobular carcinoma in situ).
Surveillance included monthly breast self-examination, clinical
breast examination every 6 months, and yearly mammography. MRI was offered as
an option starting in 1995, and ultrasonography with or without fine-needle
aspiration was performed when indicated.
A total of 76 women underwent prophylactic mastectomy, while 63
remained under regular surveillance. After a mean follow-up of 2.9 years, there
were no cases of invasive breast cancer in the prophylactic mastectomy group,
whereas eight breast cancers developed in the surveillance group (mean
follow-up, 3 years) (P = .003), said Hanne Meijers-Heijboer, MD, and
colleagues (N Engl J Med 345:159-164, 2001). The researchers noted that
the short follow-up calls for a cautious interpretation of the results.
Four cancers were detected between screening sessions, at
intervals of 2 to 5 months, and four during a screening session. "In view
of the high number of interval cancers, high-resolution imaging and more
frequent screening might be useful in women with a BRCA1/2 mutation," Dr.