The role for bilateral oophorectomy in reducing breast cancer risk in BRCA1 mutation carriers remains an area of debate (1,2). A recent paper by Kotsopoulos etal. (3) has shed further light on this question. In a large prospective cohort study of unaffected carriers (with a mean follow-up of 5.6 years), the age-adjusted hazard ratio (HR) associated with oophorectomy was 0.96 (95% confidence interval [CI] = 0.73 to 1.26), or 0.79 (95% CI = 0.55 to 1.13) if diagnosed prior to age 50 years. The multivariable hazard ratio, which adjusted for many key variables, similarly suggested no benefit for BRCA1 mutation carriers. There were, however, noteworthy differences (albeit expected) between the oophorectomy and nonoophorectomy groups across the entire (BRCA1 and BRCA2) cohort: 25.0% vs 77.1% were younger than age 40 years, and 41.5% vs 13.7% were in the key 40 to 49 years age group, respectively. The oophorectomy group was more likely to be multiparous and had a “denser” family history. Oophorectomy was also far less common for subjects from Poland (where the risk of breast cancer in BRCA1 mutation carriers is lower than in North America), who comprised 43.1% of the cohort. From a biological (rather than epidemiological) perspective, exclusion of subjects with a prior history of breast cancer could inadvertently bias against women with hormonally triggered early-onset breast cancer.

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RE：BRCA1和BRCA2突变携带者的双侧卵巢摘除术和乳腺癌风险

双侧卵巢切除术在降低BRCA1突变携带者患乳腺癌风险中的作用仍是一个有争议的领域（1,2）。Kotsopoulos等人的最新论文。（3）进一步阐明了这个问题。在一项未受影响的携带者的大型前瞻性队列研究中（平均随访5.6年），与卵巢切除术相关的年龄调整后的危险比（HR）为0.96（95％置信区间[CI] = 0.73至1.26），或如果在50岁之前被诊断为0.79（95％CI = 0.55至1.13）。调整了许多关键变量的多变量风险比类似地表明，BRCA1突变携带者无益。但是，整个卵巢切除术组和非卵巢切除术组之间（BRCA1和BRCA2）队列：年龄在40岁以下的年龄分别为25.0％和77.1％，在40至49岁的关键年龄组中分别为41.5％和13.7％。卵巢切除术组更有可能是多胎的，并且有“ denser”家族史。卵巢切除术也是从波兰（其中乳腺癌的风险科目很不常见的BRCA1突变携带者比北美更低），谁组成的队列43.1％。从生物学（而不是流行病学）的角度来看，排除具有乳腺癌病史的受试者可能会无意中偏爱荷尔蒙触发的早发性乳腺癌妇女。