Boyd et al report that, among 189 Jewish women diagnosed and treated for invasive ovarian cancer at the Memorial Sloan Kettering Cancer Center in New York, those (88 in total) with one of the three well-characterised BRCA1 or 2 mutations found in Ashkenazi Jews tended to survive longer than those without such a mutation [Boyd, J. et al (2000) JAMA 283, 2260-2265 (Abstract)]. The Jewish patients were identified from a consecutive series of almost 1000 patients treated at the centre. The vast majority of patients in the study, both with and without mutations, had advanced-stage disease. The study also showed that BRCA1-linked disease showed a stronger age-related penetrance than BRCA2-linked disease, with BRCA2-linked cases rarely diagnosed under the age of 60. Remission after chemotherapy appeared to be longer in hereditary than in sporadic cases.
Comment: The relative survival of hereditary and sporadic ovarian cancer patients is controversial, with some studies reporting enhanced survival of patients with hereditary disease and some the reverse. Boyd et al suggest that the strengths of their study are that they compared survival between groups that both had advanced-stage disease, that all the patients received the same type of treatment at the same institution, and that in restricting their study group to Jewish women they could be fairly sure that all BRCA1- or 2-linked cases had been identified. Whatever the real answer on survival, this study concurs with several others in showing that almost all hereditary ovarian cancer occurs after child-bearing age; this has important implications for counselling, as it suggests that prophylactic oophorectomy may be delayed until the woman's family is complete.