04 Oct Outcomes of Prophylactic Salpingo-Oophorectomy After BRCA1/2 Breast Cancer Resection
MedicalResearch.com Interview with:
Dr. Martelli
Gabriele Martelli, MD
Breast Unit, Surgery
Fondazione IRCCS Istituto Nazionale dei Tumori
Milan, Italy
MedicalResearch.com: What is the background for this study?
Response: Approximately 8% of breast cancer cases are associated with pathogenic germline variants of the BRCA1 or BRCA2 genes. Women with a pathogenic BRCA1 variant have lifetime risks of breast or ovarian cancer of 45% to 80% and 30% to 60%, respectively. Women with a pathogenic BRCA2 variant have lifetime risks of breast or ovarian cancer of 35% to 60% and 10% to 25%, respectively.
BRCA1 breast cancer is often more aggressive than sporadic disease, while BRCA2 breast cancer is often of similar aggressivity to sporadic disease. However, few studies have investigated outcomes of breast-conserving surgery, prophylactic mastectomy, or prophylactic salpingo-oophorectomy in patients with BRCA1/2 breast cancer. We conducted a cohort study to assess outcomes of breast-conserving surgery vs mastectomy, prophylactic mastectomy vs no prophylactic mastectomy, and prophylactic salpingo-oophorectomy vs no prophylactic salpingo-oophorectomy in patients with BRCA1/2 breast cancer.
This cohort comprised 480 consecutive breast cancer patients with a pathogenic germline variant of the BRCA1 gene (290 patients, 60.4%) or the BRCA2 gene (190 patients, 39.6%). Patients were followed prospectively from genetic testing, after undergoing surgery for breast cancer at the Italian National Cancer Institute, Milan, between 1972 and 2019. Median age at breast cancer surgery was 40 years (range 19-77 years). Tests for pathogenic BRCA1/2 variants were offered to patients with a family history of breast cancer or ovarian cancer, or with a young age at breast cancer diagnosis. All cohort patients were advised to undergo both prophylactic salpingo-oophorectomy and prophylactic mastectomy, not all chose to do so. Three hundred patients (186 with BRCA1 and 114 with BRCA2) received prophylactic salpingo-oophorectomy and 163 (97 with BRCA1 and 66 with BRCA2) received prophylactic mastectomy (bilateral if primary treatment was conservative surgery. No patient underwent hysterectomy alone.
MedicalResearch.com: What are the main findings?
Response: Prophylactic salpingo-oophorectomy was associated with a significantly reduced risk of death (p<0.001) compared with patients not receiving prophylactic salpingo-oophorectomy. This reduction was most evident in patients with a BRCA1 variant, and also in those with triple negative breast cancer. Prophylactic salpingo-oophorectomy was not associated with risk of contralateral breast cancer or ipsilateral breast tumor recurrence. Initial or delayed prophylactic mastectomy was associated with a reduced risk of ipsilateral breast tumor recurrence but not with overall survival or breast cancer-specific mortality.
MedicalResearch.com: What should readers take away from your report?
Response: For breast cancer patients with a pathogenic BRCA1/2 variant who undergo breast cancer surgery, prophylactic salpingo-oophorectomy should be performed as early as possible, particularly in those with the BRCA1 variant, in order to reduce overall mortality.
Citation: Martelli G, Barretta F, Vernieri C, et al. Prophylactic Salpingo-Oophorectomy and Survival After BRCA1/2 Breast Cancer Resection. JAMA Surg. Published online October 04, 2023. doi:10.1001/jamasurg.2023.4770
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