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abstract:
Do breast cancer survivors benefit from prophylactic removal of uterus and ovaries? A population-based data linkage replication study
27 MAY 2016
Abstract
Aim
Our
previous population-based research found prophylactic surgery
(hysterectomy and bilateral salpingo-oophorectomy [BSO]) halved the
mortality risk for premenopausal breast cancer patients. Here we aim to
replicate findings in a Western Australia dataset.
Method
Data
from the Western Australia Cancer Registry of 15 395 women 20–79 years
diagnosed with primary breast cancer (1997–2011) was categorized into
four groups: neither hysterectomy nor BSO, hysterectomy only, BSO only,
or hysterectomy + BSO. We fitted flexible parametric breast
cancer–specific and overall survival models with 95% confidence
intervals (also known as Royston–Parmar models) to assess the impact of
prophylactic surgery.
Results
A
total of 12 630 (82.0%) patients had no surgery, 1799 (11.7%) had a
hysterectomy only, 337 (2.2%) had BSO only and 629 (4.1%) had both a
hysterectomy and BSO. For all-causes mortality, unadjusted 10-year
survival was highest for women who had either a hysterectomy + BSO
(84.7%) or a hysterectomy only (84.2%). After adjusting for covariates,
the survival advantage compared to women without any surgery remained
significant for the hysterectomy only group (hazard ratio [HR] = 0.89;
95% confidence interval [CI], 0.81–0.98; P = 0.02). A similar
pattern emerged in breast cancer–specific survival with significantly
improved survival for women who had a hysterectomy only (HR = 0.83; 95%
CI, 0.74–0.94; P = 0.003). However, for non-breast
cancer-related survival, having a BSO alone increased risk of death (HR =
1.83; 95% CI, 1.14–2.93; P = 0.01).
Conclusion
We
observed significantly improved overall and breast cancer-specific
survival among women who had a hysterectomy only, but increased
non-breast cancer-related risk after BSO only. Breast cancer patients
must weigh up pros and cons of prophylactic surgery.
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