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).
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.
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.
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- A strong candidate for the breast and ovarian cancer susceptibility gene BRCA1.Science. 1994; 266: 66-71https://doi.org/10.1126/science.7545954
- Identification of the breast cancer susceptibility gene BRCA2.Nature. 1995; 378: 789-792https://doi.org/10.1038/378789a0
- The BRCA tumor suppressor network in chromosome damage repair by homologous recombination.Annu Rev Biochem. 2019; 88: 221-245https://doi.org/10.1146/annurev-biochem-013118-111058
- Cancer risks among BRCA1 and BRCA2 mutation carriers.Br J Cancer. 2007; 96: 11-15https://doi.org/10.1038/sj.bjc.6603535
- The association of BRCA1 and BRCA2 mutations with prostate cancer risk, frequency, and mortality: a meta-analysis.Prostate. 2019; 79: 880-895https://doi.org/10.1002/pros.23795
- The role of BRCA1 and BRCA2 mutations in prostate, pancreatic and stomach cancers.Hered Cancer Clin Pract. 2015; 13: 16https://doi.org/10.1186/s13053-015-0038-x
- Association between inherited germline mutations in cancer predisposition genes and risk of pancreatic cancer.JAMA, J Am Med Assoc. 2018; 319: 2401-2409https://doi.org/10.1001/jama.2018.6228
- Variation of breast cancer risk among BRCA1/2 carriers.JAMA, J Am Med Assoc. 2008; 299: 194-201https://doi.org/10.1001/jama.2007.55-a
- Meta-analysis of BRCA1 and BRCA2 penetrance.J Clin Oncol. 2007; 25: 1329-1333https://doi.org/10.1200/JCO.2006.09.1066
- Cancer risks for BRCA1 and BRCA2 mutation carriers: results from prospective analysis of EMBRACE.J Natl Cancer Inst. 2013; 105: 812-822https://doi.org/10.1093/jnci/djt095
- Pathology and gene expression of hereditary breast tumors associated with BRCA1, BRCA2 and CHEK2 gene mutations.Oncogene. 2006; 25: 5837-5845https://doi.org/10.1038/sj.onc.1209875
- The role of genetic testing in patients with breast cancer a review.JAMA Surg. 2017; 152: 589-594https://doi.org/10.1001/jamasurg.2017.0552
- The pathology of familial breast cancer: predictive value of immunohistochemical markers estrogen receptor, progesterone receptor, HER-2, and p53 in patients with mutations in BRCA1 and BRCA2.J Clin Oncol. 2002; 20: 2310-2318https://doi.org/10.1200/JCO.2002.09.023
- Multifactorial analysis of differences between sporadic breast cancers and cancers involving BRCA1 and BRCA2 mutations.J Natl Cancer Inst. 1998; 90: 1138-1145https://doi.org/10.1093/jnci/90.15.1138
- Clinical and pathologic characteristics of patients with BRCA-positive and BRCA-negative breast cancer.J Clin Oncol. 2008; 26: 4282-4288https://doi.org/10.1200/JCO.2008.16.6231
- Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer.N Engl J Med. 2002; 347: 1227-1232https://doi.org/10.1056/NEJMoa020989
- Prognostic impact of breast-conserving therapy versus mastectomy of BRCA1/2 mutation carriers compared with noncarriers in a consecutive series of young breast cancer patients.Ann Surg. 2019; 270: 364-372https://doi.org/10.1097/SLA.0000000000002804
- Breast-conserving therapy is safe both within BRCA1/2 mutation carriers and noncarriers with breast cancer in the Chinese population.Gland Surg. 2020; 9: 775-787https://doi.org/10.21037/GS-20-531
- Breast-conserving therapy for breast cancer with BRCA mutations: a meta-analysis.Breast Cancer. 2021; https://doi.org/10.1007/s12282-021-01312-2
- Breast conserving surgery for BRCA mutation carriers—a systematic review.Clin Breast Cancer. 2020; 20: e244-e250https://doi.org/10.1016/j.clbc.2019.07.014
- High risk of in-breast tumor recurrence after BRCA1/2-associated breast cancer.Breast Cancer Res Treat. 2014; 147: 571-578https://doi.org/10.1007/s10549-014-3115-3
- Local therapy in BRCA1 and BRCA2 mutation carriers with operable breast cancer: comparison of breast conservation and mastectomy.Breast Cancer Res Treat. 2010; 121: 389-398https://doi.org/10.1007/s10549-010-0894-z
- Local recurrences and distant metastases after conservative breast cancer treatments: partly independent events.J Natl Cancer Inst. 1995; 87: 19-27https://doi.org/10.1093/jnci/87.1.19
- Combined breast conservation therapy versus mastectomy for BRCA mutation carriers – a systematic review and meta-analysis.Breast. 2021; 56: 26-34https://doi.org/10.1016/j.breast.2021.02.001
- Surgical management of breast cancer in BRCA-mutation carriers: a systematic review and meta-analysis.Breast Cancer Res Treat. 2014; 144: 443-455https://doi.org/10.1007/s10549-014-2890-1
- Ten-year multi-institutional results of breast-conserving surgery and radiotherapy in BRCA1/2-associated stage I/II breast cancer.J Clin Oncol. 2006; 24: 2437-2443https://doi.org/10.1200/JCO.2005.02.7888
- Cumulative risk of second primary contralateral breast cancer in BRCA1/BRCA2 mutation carriers with a first breast cancer: a systematic review and meta-analysis.Breast. 2014; 23: 721-742https://doi.org/10.1016/j.breast.2014.10.005
- True recurrence versus new primary: an analysis of ipsilateral breast tumor recurrences after breast-conserving therapy.Int J Radiat Oncol Biol Phys. 2011; 81: 409-417https://doi.org/10.1016/j.ijrobp.2010.05.063
- Breast surgery for young women with early-stage breast cancer: mastectomy or breast-conserving therapy?.Medicine (Baltim). 2021; 100e25880https://doi.org/10.1097/MD.0000000000025880
- Breast-conserving surgery in BRCA1/2 mutation carriers: are we approaching an answer?.Ann Surg Oncol. 2009; 16: 3380-3387https://doi.org/10.1245/s10434-009-0638-7
- Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial.JAMA, J Am Med Assoc. 2017; 318: 918-926https://doi.org/10.1001/jama.2017.11470
- Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation.N Engl J Med. 2002; 347: 567-575https://doi.org/10.1056/nejmoa020128
- Impact of preoperative BRCA1/2 testing on surgical decision making in patients with newly diagnosed breast cancer.Breast J. 2018; 24: 541-548https://doi.org/10.1111/tbj.13007
Published online: April 30, 2022
Accepted: April 27, 2022
Received in revised form: March 25, 2022
Received: January 31, 2022
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