Long-Term Ovarian Cancer Survival Associated With Mutation in BRCA1 or BRCA2

The majority of women diagnosed with invasive ovarian cancer in Canada or the United States will succumb to their disease, but approximately 35% of women with ovarian cancer (including 20% of patients with serous cancers) are expected to be long-term survivors and ultimately cured (1). Overall, 13% of unselected case patients of ovarian cancer are attributable to mutations in BRCA1 or BRCA2 (2,3). Several studies have examined survival after ovarian cancer for women with BRCA1 or BRCA2 mutations (4–14), and most report better survival for women with mutations (4,6–14). Observed differences in survival may be the result of differences in the intrinsic aggressiveness of hereditary vs nonhereditary cancers, differences in the ages of diagnosis and/or histologic subtypes, or differences in the response to chemotherapy. Many studies published to date have followed case patients for relatively short periods of time. This approach is valid if the relative hazard associated with a gene mutation is constant over time, but if the assumption of hazards proportionality is violated, then a long period of follow-up is necessary to permit proper comparison of survivorship. In many studies, the hereditary case patients and the group of comparison patients were derived from different populations (5,6,9,11,13,14). Additionally, many studies involved less than 50 hereditary case patients (4,7–9,12), and some studies did not properly adjust for survivorship bias (5,11–13). We sought to estimate 10-year survival for women with ovarian cancer, with and without mutations in BRCA1 or BRCA2, to determine whether or not the observed short-term survival benefit for mutation carriers is associated with a better prospect for cure.