Hormone therapy replacement in oncological high risk patients: is itpossible?

Abstract

High oncological risk patients: what do we have for sure?A germline mutation in BRCA1 or BRCA2 results in a significantly elevated lifetime risk of developing breast cancer (BC) and ovarian cancer (OC). Indeed, more than 90% of hereditary cases of BC and OC are thought to be a result of a mutation in BRCA1/2. 1 In patients with BRCA1 mutations, cumulative risk of BC and OC by age 80 is about 72% and 44% respectively; for BRCA2 mutations, that risk is about 69% and 17% respectively. 2 Therefore, the NCCN Guidelines Panel recommends RRSO for women with a known BRCA1/2 mutation, between the ages of 35 and 40 with a BRCA1 mutation and between 40 and 45 years of age in women with a BRCA2 mutation, since ovarian cancer onset tends to be later in this group 3 RRSO is associated with an OC risk-reduction of approximately 80% and it also seems to reduce BC risk by approximately 50%. All-cause mortality was lower for BRCA carriers who undergo RRSO (HR 0.40, 95% CI 0.26-0.61), as well as breast cancer specific (HR 0.44, 95% CI 0.26-0.76), and ovarian cancer specific mortality (HR 0.21, 95% CI 0.06-0.80). 4 The largest reduction in mortality after RRSO was due to a decrease in ovarian cancer specific mortality, which was the predominant reason for improved all-cause mortality in these women. 2 The role of bilateral risk-reducing mastectomy is still controversial.