Effect of prevention strategies on survival and quality-adjusted survival of women with BRCA1/2 mutations: An updated decision analysis

Victor R. Grann, Judith S. Jacobson, Dustin Thomason, Dawn Hershman, Daniel F. Heitjan, Alfred I. Neugut

Research output: Contribution to journalArticle

122 Citations (Scopus)

Abstract

Purpose: This study updates findings regarding the effects of prophylactic surgery, chemoprevention, and surveillance on the survival and quality-adjusted survival of women who test positive for BRCA1/2 mutations. Materials and Methods: Markov modeling of outcomes was performed in a simulated cohort of 30-year-old women who tested positive for BRCA1/2 mutations. The model incorporated breast and ovarian cancer incidence rates from the literature and mortality rates from the Surveillance, Epidemiology, and End Results Program. Quality adjustment of survival estimates were obtained from a survey of women aged 33 to 50 years. Sensitivity analyses were performed of varied assumptions regarding timing and effects of preventive measures on cancer incidence and adverse effects. Results: A 30-year-old woman could prolong her survival beyond that associated with surveillance alone by use of preventive measures: 1.8 years with tamoxifen, 2.6 years with prophylactic oophorectomy, 4.6 years with both tamoxifen and prophylactic oophorectomy, 3.5 years with prophylactic mastectomy, and 4.9 years with both surgeries. She could prolong her quality-adjusted survival by 2.8 years with tamoxifen, 4.4 years with prophylactic oophorectomy, 6.3 years with tamoxifen and oophorectomy, and 2.6 years with mastectomy, or with both surgeries. The benefits of all of these strategies would decrease if they were initiated at later ages. Conclusion: Women who test positive for BRCA1/2 mutations may derive greater survival and quality adjusted survival benefits than previously reported from chemoprevention, prophylactic surgery, or a combination. Observational studies and clinical trials are needed to verify the results of this analysis of the long-term benefits of preventive strategies among BRCA1/2-positive women.

Original languageEnglish (US)
Pages (from-to)2520-2529
Number of pages10
JournalJournal of Clinical Oncology
Volume20
Issue number10
DOIs
StatePublished - May 15 2002

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Decision Support Techniques
Ovariectomy
Mutation
Tamoxifen
Survival
Chemoprevention
SEER Program
Mastectomy
Incidence
Ovarian Neoplasms
Observational Studies
Clinical Trials
Breast Neoplasms
Mortality
Neoplasms

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Effect of prevention strategies on survival and quality-adjusted survival of women with BRCA1/2 mutations : An updated decision analysis. / Grann, Victor R.; Jacobson, Judith S.; Thomason, Dustin; Hershman, Dawn; Heitjan, Daniel F.; Neugut, Alfred I.

In: Journal of Clinical Oncology, Vol. 20, No. 10, 15.05.2002, p. 2520-2529.

Research output: Contribution to journalArticle

Grann, Victor R. ; Jacobson, Judith S. ; Thomason, Dustin ; Hershman, Dawn ; Heitjan, Daniel F. ; Neugut, Alfred I. / Effect of prevention strategies on survival and quality-adjusted survival of women with BRCA1/2 mutations : An updated decision analysis. In: Journal of Clinical Oncology. 2002 ; Vol. 20, No. 10. pp. 2520-2529.
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