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Randomized Controlled Trial
. 2021 Jun;21(3):e168-e176.
doi: 10.1016/j.clbc.2020.11.002. Epub 2020 Nov 10.

Lifestyle Characteristics in Women Carriers of BRCA Mutations: Results From an Italian Trial Cohort

Eleonora Bruno  1 , Andreina Oliverio  1 , Angelo Paradiso  2 , Antonella Daniele  3 , Stefania Tommasi  4 , Daniela A Terribile  5 , Alessio Filippone  6 , Maria Digennaro  2 , Brunella Pilato  4 , Katia Danza  4 , Donatella Guarino  6 , Cristina Rossi  7 , Maria Maddalena Rossi  7 , Elisabetta Venturelli  1 , Marta Giussani  8 , Bernard Peissel  9 , Patrizia Pasanisi  10
Affiliations
Randomized Controlled Trial

Lifestyle Characteristics in Women Carriers of BRCA Mutations: Results From an Italian Trial Cohort

Eleonora Bruno et al. Clin Breast Cancer. 2021 Jun.

Abstract

Background: Women with deleterious mutations in BRCA1/2 have a high lifetime penetrance of developing breast cancer and/or ovarian cancer. Genetic and/or environmental factors may influence BRCA penetrance, and identifying modifiable exposures might be valuable for prevention.

Patients and methods: We implemented a multicenter prospective 2-arm (1:1) randomized controlled trial to investigate whether a Mediterranean dietary intervention with moderate protein restriction would reduce potential modulators of BRCA penetrance such as insulin-like growth factor 1 (IGF-1), body weight, and metabolic risk factors. We studied the baseline characteristics of women with BRCA-positive disease who joined the trial cohort, focusing on the relationships between selected lifestyle exposures, metabolic/anthropometric parameters, and BRCA-related cancer.

Results: A total of 502 women (304 with a previous diagnosis of breast cancer and/or ovarian cancer and 198 unaffected) with deleterious BRCA mutations, with or without a previous cancer, aged 18 to 70 years and without metastases were included. Late age at menarche and pregnancy were negatively associated with BRCA-related cancer, especially in women with BRCA1-positive disease. Higher fat mass and the presence of 4 or 5 metabolic risk factors were significantly associated with BRCA-related cancer (hazard ratio, 1.87, 95% confidence interval, 1.21-2.88; and hazard ratio, 1.87, 95% confidence interval, 1.11-3.19, respectively), with greater effect in BRCA2-positive women.

Conclusions: Our findings confirm previous observations about reproductive factors in women with BRCA disease and suggest a potential impact of metabolic factors in BRCA-related cancer. The prospective follow-up of the trial cohort will enable us to study the environmental modulators of BRCA penetrance and their impact in relation to the history of BRCA-related cancer. [ClinicalTrials.gov NCT03066856].

Keywords: BRCA mutation; BRCA penetrance; BRCA-related cancer; Environmental exposure; Personalized medicine.

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