Aromatase inhibitors and contralateral breast cancer in BRCA mutation carriers

Maryam Nemati Shafaee, Kristina Goutsouliak, Heather Lin, Therese B. Bevers, Angelica Gutierrez-Barrera, Melissa Bondy, Banu Arun

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: Deleterious BRCA mutations confer a significant lifetime risk of breast cancer (BC) as well as contralateral BC (CBC) in patients who do not undergo prophylactic mastectomy. Prior reports have suggested that tamoxifen reduces the risk of CBC in BRCA mutation carriers. Whether aromatase inhibitors (AI) have the same effect is unknown. Methods: This is a retrospective review of patients diagnosed with non-metastatic ER+ BC between 2004 and 2014 with known BRCA mutation status. Patients were followed from primary diagnosis until CBC diagnosis or death. Median follow-up was 11.5 years. Risk of CBC was evaluated as time to event. Results: 935 subjects were included in this analysis, with 53 BRCA1 mutation carriers, and 94 BRCA2 mutation carriers. Median age at diagnosis was 42.7 years. Seventy-two percent (676) received tamoxifen and 43% (405) received AI. A total of 66 CBCs occurred, of which 10% (15/147) occurred in BRCA mutation carriers vs 6.5% (51/788) in BRCA wild type. Multivariate analyses indicated that BRCA status and AI use were significantly associated with CBC risk. AI use resulted in a significant reduction in risk of CBC (HR 0.44, p = 0.004) regardless of the BRCA mutation status. Tamoxifen use was not associated with reduced risk of CBC. Conclusions: This is the first report showing that AIs reduce the risk of CBC in BRCA mutation carriers. The potential role of AIs as chemoprevention should be validated in larger independent cohorts.

Original languageEnglish (US)
Pages (from-to)143-152
Number of pages10
JournalBreast Cancer Research and Treatment
Volume196
Issue number1
DOIs
StatePublished - Nov 2022

Keywords

  • Aromatase inhibitors
  • BRCA mutation
  • BRCA1/2
  • Breast cancer
  • Chemoprevention
  • High risk
  • Tamoxifen

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

MD Anderson CCSG core facilities

  • Biostatistics Resource Group

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