Abstract
Introduction
The optimal surgical management of BRCA-mutation carriers remains a subject of debate.
To evaluate the appropriateness of breast cancer (BC) treatment, the oncological outcomes
of BRCA-mutation carriers treated either with breast-conserving therapy (BCT) or mastectomy
were compared. Additionally, the role of bilateral salpingo-oophorectomy (BSO) and
potential independent predictive factors for BC treatment were analyzed.
Materials and methods
We retrospectively reviewed all the consecutive patients with a pathogenic germline
mutation in the BRCA1/2 genes tested at our Institution between July 2008 and October
2018. Primary end-points were disease-free survival (DFS), distant disease-free survival
(DDFS), and overall survival (OS).
Results
The characteristics and outcomes of 124 BRCA-associated BC patients were analyzed.
Overall, 69 (55.7%) and 55 (44.3%) patients underwent BCT and mastectomy, respectively;
72 (58.1%) patients underwent BSO. After a median interval of 13.3 months, 24 patients
underwent mastectomy after primary BCT. There was no significant difference in terms
of DFS, DDFS, and OS between patients treated with BCT or mastectomy (p = 0.39,p = 0.27,p = 0.265, respectively). Patients treated with BSO had significantly better DDFS and
OS compared to ovarian conservation (p = 0.033,p = 0.040, respectively). Three independent predictive factors for BCT were identified:
age ≤41 years, genetic testing performed post-operatively, and breast tumors ≤21 mm.
Conclusions
Our data suggest that BRCA-mutation carriers treated with BCT present similar oncological
outcomes compared to mastectomy. Ovarian preservation decreases survival. Young BRCA-mutated
patients with small BCs may not need up-front mastectomy, and BSO might be performed
when ovarian cancer risk epidemiologically rises and potential reproductive desire
is fulfilled.
Keywords
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Article info
Publication history
Published online: April 30, 2022
Accepted:
April 27,
2022
Received in revised form:
March 25,
2022
Received:
January 31,
2022
Identification
Copyright
© 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
