Risk-reducing mastectomy (RRM) can increase life expectancy and be cost effective in women up to age 60 years with ovarian cancer as carriers of a BRCA mutation. As age increases beyond 60 years, however, survival advantages decrease such that RRM is no longer beneficial or cost effective. These results were presented at the Society for Gynecologic Oncology’s 2016 Annual Meeting on Women’s Cancer.1
The Society for Gynecologic Oncology recommends that women with epithelial ovarian cancer assess their genetic risk for developing breast cancer. Women who are genetically at higher risk for subsequently developing breast cancer need an informed method to determine whether RRM is beneficial.
Researchers used a mathematical model to examine cost and life expectancy outcomes using prospective data on breast cancer incidence in BRCA mutation carriers. They compared the effects on cost benefit and life expectancy of 2 different treatment strategies in women BRCA mutation carriers with stage II to IV ovarian cancer.
The 2 different treatment strategies were RRM and annual MRI and mammography screening. Ages at ovarian cancer diagnosis were 40, 50, 60, and 70 years. Survival data for ovarian and breast cancers were obtained from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.
When a BRCA1 mutation carrier woman was age 40 years at ovarian cancer diagnosis, RRM increased life expectancy by 8 months compared with MRI and mammography. The incremental cost effectiveness ratio (ICER) for RRM was $12 298/year of life saved. At 50, 60, and 70 years, RRM increased life expectancy 6, 3, and 1.5 months, respectively, with ICERs of $24 255, $56 881, and $143 207/year of life saved, respectively.
BRCA2 mutation carriers age 40, 50, 60, or 70 years at ovarian cancer diagnosis experience life expectancy extensions of 7, 5, 3, and 2 months, respectively, with RRM. Cost effectiveness disappears at age 70 years, when ICER is $119 557/year of life saved.
“For women with OC [ovarian cancer] diagnosed before age 60 and who are at high genetic risk, RRM achieves modest life expectancy gains, with an acceptable cost increase compared to annual breast screening. Above age 60 at OC diagnosis, RRM is unlikely to be cost-effective, with diminishing gains in life expectancy,” wrote the researchers.
1. Gamble CR, Havrilesky LJ, Hollenbeck S, Myers ER, Greenup R. Value of prophylactic mastectomy in BRCA mutation carriers with ovarian cancer. Presentation at: 47th Annual Meeting of the Society of Gynecologic Oncology; March 19-22, 2016; San Diego, California. Abstract 141.