Oncogenetics Unit, Institute of Human Genetics, and Meirav High Risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Genetics Institute and NOGA High Risk Clinic, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel.
Cancer. 2019 Mar 1;125(5):698-703. doi: 10.1002/cncr.31842. Epub 2018 Nov 29.
BACKGROUND: BRCA1/2 mutation carriers have an increased risk of developing ovarian cancer, leading to the recommendation of risk-reducing salpingo-oophorectomy (RRSO) at 35-40 years of age. The role, if any, that BRCA mutations play in conferring uterine cancer risk, is unresolved. METHOD: Jewish Israeli women, carriers of one of the predominant Jewish mutations in BRCA1/2 from 1998 to 2016, were recruited. Cancer diagnoses were determined through the Israeli National Cancer Registry. Uterine cancer risk was assessed by computing the standardized incidence ratio of observed-to-expected number of cases, using the exact 2-sided P value of Poisson count. RESULTS: Overall, 2627 eligible mutation carriers were recruited from 1998 to 2016, 2312 (88%) of whom were Ashkenazi Jews (1463 BRCA1, 1154 BRCA2 mutation carriers, 10 double mutation carriers). Among these participants, 1310 underwent RRSO without hysterectomy at a mean (± standard deviation) age of 43.6 years (± 4.4 years). During 32,774 women-years of follow up, 14 women developed uterine cancer, and the observed-to-expected rate of all histological subtypes was 3.98 (95% confidence interval [CI], 2.17-6.67; P < .001). For serous papillary (n = 5), the observed-to-expected ratio was 14.29 (95% CI, 4.64-33.34; P < .001), and for sarcoma (n = 4) it was 37.74 (95% CI, 10.28-96.62). These rates were also higher than those detected in a group of 1844 age- and ethnicity-matched women (53% with breast cancer). CONCLUSION: Israeli BRCA1 or BRCA2 mutation carriers are at an increased risk for developing uterine cancer, especially serous papillary and sarcoma. These elevated risks of uterine cancer should be discussed with BRCA carriers.
背景:BRCA1/2 基因突变携带者患卵巢癌的风险增加,因此建议其在 35-40 岁时进行降低风险的输卵管卵巢切除术(RRSO)。BRCA 突变在多大程度上导致子宫癌风险尚不清楚。
方法:从 1998 年至 2016 年,招募了携带 BRCA1/2 中一种主要犹太突变的以色列裔犹太妇女。通过以色列国家癌症登记处确定癌症诊断。通过计算观察到的病例数与预期病例数的标准化发病比来评估子宫癌风险,使用泊松计数的精确双侧 P 值。
结果:总体而言,从 1998 年至 2016 年共招募了 2627 名符合条件的突变携带者,其中 2312 名(88%)为阿什肯纳兹犹太人(1463 名 BRCA1 突变携带者,1154 名 BRCA2 突变携带者,10 名双突变携带者)。在这些参与者中,1310 人在平均(±标准差)43.6 岁(±4.4 岁)时接受了 RRSO 而未行子宫切除术。在 32774 名女性随访年中,有 14 名女性发生了子宫癌,所有组织学亚型的观察到的与预期的比率为 3.98(95%置信区间 [CI],2.17-6.67;P <.001)。对于浆液性乳头状(n = 5),观察到的与预期的比率为 14.29(95%CI,4.64-33.34;P <.001),对于肉瘤(n = 4)为 37.74(95%CI,10.28-96.62)。这些比率也高于在 1844 名年龄和种族匹配的女性(53%患有乳腺癌)组中检测到的比率。
结论:以色列 BRCA1 或 BRCA2 基因突变携带者患子宫癌的风险增加,尤其是浆液性乳头状癌和肉瘤。应与 BRCA 携带者讨论这些增加的子宫癌风险。
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