Survival after bilateral risk-reducing mastectomy in healthy BRCA1 and BRCA2 mutation carriers

Bernadette A. M. Heemskerk-Gerritsen*, Agnes Jager, Linetta B. Koppert, A. Inge-Marie Obdeijn, Margriet Collee, Hanne E. J. Meijers-Heijboer, Denise J. Jenner, Hester S. A. Oldenburg, Klaartje van Engelen, Jakob de Vries, Christi J. van Asperen, Peter Devilee, Marinus J. Blok, C. Marleen Kets, Margreet G. E. M. Ausems, Caroline Seynaeve, Matti A. Rookus, Maartje J. Hooning

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background In healthy BRCA1/2 mutation carriers, bilateral risk-reducing mastectomy (BRRM) strongly reduces the risk of developing breast cancer (BC); however, no clear survival benefit of BRRM over BC surveillance has been reported yet. Methods In this Dutch multicenter cohort study, we used multivariable Cox models with BRRM as a time-dependent covariable to estimate the associations between BRRM and the overall and BC-specific mortality rates, separately for BRCA1 and BRCA2 mutation carriers. Results During a mean follow-up of 10.3 years, 722 out of 1712 BRCA1 (42%) and 406 out of 1145 BRCA2 (35%) mutation carriers underwent BRRM. For BRCA1 mutation carriers, we observed 52 deaths (20 from BC) in the surveillance group, and 10 deaths (one from BC) after BRRM. The hazard ratios were 0.40 (95% CI 0.20-0.90) for overall mortality and 0.06 (95% CI 0.01-0.46) for BC-specific mortality. BC-specific survival at age 65 was 93% for surveillance and 99.7% for BRRM. For BRCA2 mutation carriers, we observed 29 deaths (7 from BC) in the surveillance group, and 4 deaths (no BC) after BRRM. The hazard ratio for overall mortality was 0.45 (95% CI 0.15-1.36). BC-specific survival at age 65 was 98% for surveillance and 100% for BRRM. Conclusion BRRM was associated with lower mortality than surveillance for BRCA1 mutation carriers, but for BRCA2 mutation carriers, BRRM may lead to similar BC-specific survival as surveillance. Our findings support a more individualized counseling based on BRCA mutation type.

Original languageEnglish
Pages (from-to)723-733
Number of pages11
JournalBreast Cancer Research and Treatment
Issue number3
Publication statusPublished - Oct 2019


  • BRCA1
  • 2
  • Bilateral risk-reducing mastectomy
  • Prevention
  • Surveillance
  • Survival
  • TIME


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