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Clinical characteristics and outcomes in elderly women with BRCA1 and BRCA2 mutations

  • Chelsea Salyer
    Affiliations
    Kaiser Permanente Obstetrics and Gynecology Residency Program, Oakland, CA, United States of America

    Kaiser Permanente Genetics Department, San Francisco, CA, United States of America

    Rebecca and John Moores Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, La Jolla, CA, United States of America

    Kaiser Permanente Oakland Department of Graduate Medical Education, Oakland, CA, United States of America

    Kaiser Permanente Northern California Gynecologic Oncology Program, San Francisco, CA, United States of America
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  • Christine Kobelka
    Affiliations
    Kaiser Permanente Obstetrics and Gynecology Residency Program, Oakland, CA, United States of America

    Kaiser Permanente Genetics Department, San Francisco, CA, United States of America

    Rebecca and John Moores Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, La Jolla, CA, United States of America

    Kaiser Permanente Oakland Department of Graduate Medical Education, Oakland, CA, United States of America

    Kaiser Permanente Northern California Gynecologic Oncology Program, San Francisco, CA, United States of America
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  • Allison Barrie
    Affiliations
    Kaiser Permanente Obstetrics and Gynecology Residency Program, Oakland, CA, United States of America

    Kaiser Permanente Genetics Department, San Francisco, CA, United States of America

    Rebecca and John Moores Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, La Jolla, CA, United States of America

    Kaiser Permanente Oakland Department of Graduate Medical Education, Oakland, CA, United States of America

    Kaiser Permanente Northern California Gynecologic Oncology Program, San Francisco, CA, United States of America
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  • Miranda Ritterman Weintraub
    Affiliations
    Kaiser Permanente Obstetrics and Gynecology Residency Program, Oakland, CA, United States of America

    Kaiser Permanente Genetics Department, San Francisco, CA, United States of America

    Rebecca and John Moores Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, La Jolla, CA, United States of America

    Kaiser Permanente Oakland Department of Graduate Medical Education, Oakland, CA, United States of America

    Kaiser Permanente Northern California Gynecologic Oncology Program, San Francisco, CA, United States of America
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  • C. Bethan Powell
    Correspondence
    Corresponding author at: Kaiser Permanente Northern California Gynecologic Cancer Program, 2350 Geary Blvd, San Francisco, CA 94115, United States of America.
    Affiliations
    Kaiser Permanente Obstetrics and Gynecology Residency Program, Oakland, CA, United States of America

    Kaiser Permanente Genetics Department, San Francisco, CA, United States of America

    Rebecca and John Moores Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, La Jolla, CA, United States of America

    Kaiser Permanente Oakland Department of Graduate Medical Education, Oakland, CA, United States of America

    Kaiser Permanente Northern California Gynecologic Oncology Program, San Francisco, CA, United States of America

    Division of Research, Kaiser Permanente Northern California, Oakland CA, United States of America
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      Highlights

      • Elderly BRCA carriers were more likely to opt for ongoing breast surveillance rather than RRM.
      • A large proportion of elderly women elected RRSO after BRCA testing and very few opted for ovarian cancer surveillance.
      • Pancreatic cancer was the most common new cancer diagnosed in older BRCA carriers.

      Abstract

      Objective

      Describe clinical characteristics and risk reducing strategies utilized among women with a BRCA mutation who lived to age 75 and above.

      Methods

      A retrospective study of women with BRCA mutations identified from 1995 to 2015 in a California health care system. From a database of 1189 women, 69 participants were identified who lived to age 75 or older. Demographic and clinical characteristics were recorded, as well as cancer history and risk-reducing strategies utilized. Descriptive and bivariate analyses were used to analyze the cohort.

      Results

      The median age of the cohort at study entry was 78 (IQR: 76–84) and the median age at time of genetic testing was 73 (IQR 68–79). Fifty (72%) women had a prior history of breast cancer and 27 (39%) had a history of ovarian cancer. Three of 19 (16%) women with no history of breast cancer elected to undergo a risk-reducing mastectomy (RRM) after their positive genetic test. Among 30 women with ovaries still in place, 14 (47%) underwent a risk-reducing salpingo-oophorectomy (RRSO); six were age 70 or older at the time of surgery. Four (6%) women in the cohort developed BRCA-related cancer after testing, one developed breast cancer and three developed pancreatic cancer.

      Conclusions

      Most women with BRCA mutations surviving beyond age 75 received their genetic test result at an older age and had a history of BRCA-related cancer. Women continued surveillance and risk reducing surgeries at an older age. Pancreatic cancer was the most common new cancer diagnosed in older BRCA mutation carriers.

      Keywords

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