Surgical management of BRCA-mutation carriers: A single institution experience

Damiano Gentile; Agnese Losurdo; Andrea Sagona; Monica Zuradelli; Wolfgang Gatzemeier; Erika Barbieri; Alberto Testori; Valentina Errico; Paolo Bianchi; Ersilia Biondi; Rosalba Torrisi; Armando Santoro; Corrado Tinterri

doi:10.1016/j.ejso.2022.04.024

Surgical management of BRCA-mutation carriers: A single institution experience

Eur J Surg Oncol. 2022 Aug;48(8):1706-1712. doi: 10.1016/j.ejso.2022.04.024. Epub 2022 Apr 30.

Affiliations

¹ Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy. Electronic address: damiano.gentile@humanitas.it.
² Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
³ Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
⁴ Laboratory Analysis Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
⁵ Division of Breast Surgery, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy.
⁶ Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
⁷ Breast Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.

PMID: 35534308
DOI: 10.1016/j.ejso.2022.04.024

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: BRCA; Breast cancer; Breast-conserving therapy; Mastectomy; Salpingo-oophorectomy.

MeSH terms

Adult
Breast Neoplasms* / genetics
Breast Neoplasms* / pathology
Breast Neoplasms* / surgery
Female
Genes, BRCA2
Humans
Mastectomy*
Mutation
Retrospective Studies