Do breast cancer survivors benefit from prophylactic removal of uterus and ovaries? A population-based data linkage replication study
Obermair, Andreas, Youlden, Danny, Baade, Peter, & Janda, Monika (2016) Do breast cancer survivors benefit from prophylactic removal of uterus and ovaries? A population-based data linkage replication study. Asia-Pacific Journal of Clinical Oncology. (In Press)
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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.
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.
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).
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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|Item Type:||Journal Article|
|Keywords:||breast cancer, ovarian cancer, prophylactic surgery, survival, uterine cancer|
|Subjects:||Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > PUBLIC HEALTH AND HEALTH SERVICES (111700)
Australian and New Zealand Standard Research Classification
|Divisions:||Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Public Health & Social Work
|Copyright Owner:||Copyright 2016 John Wiley & Sons Australia, Ltd|
|Copyright Statement:||This is the peer reviewed version of the following article: OBERMAIR, A., YOULDEN, D., BAADE, P. and JANDA, M. (2016), Do breast cancer survivors benefit from prophylactic removal of uterus and ovaries? A population-based data linkage replication study. Asia-Pacific Journal of Clinical Oncology, which has been published in final form at https://doi.org/10.1111/ajco.12508. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.|
|Deposited On:||16 Aug 2016 23:19|
|Last Modified:||23 Aug 2016 17:40|
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