Download Does risk-reducing surgery improve overall survival in BRCA1

Does risk-reducing surgery improve overall survival in BRCA1-2 mutation carriers?
Mehra Golshan
Greater understanding regarding the role risk-reducing surgery has on the development of
future breast cancer and on the survival of women with BRCA mutations can improve clinicians’
abilities to counsel patients regarding treatment decisions. With an increased lifetime risk of
65-85% for a primary BC and a 10-year 30% risk of developing an additional second primary BC,
women with BRCA mutations are considered ideal candidates for targeted risk reduction efforts
[1-3]. Risk-reduction options include close surveillance, chemoprevention, and prophylactic
surgeries [1, 4]. Prophylactic surgical procedures includes bilateral risk-reducing mastectomy
(BRRM), risk-reducing salpingo-oophorectomy (RRSO), and contralateral mastectomy (CM, for
patients with unilateral BC diagnoses). These surgeries appear to have a clear role in riskreduction of future BC development; however their role in improving overall breast-cancer
specific survival is more controversial. Although randomized trials are lacking, recent research
suggests an apparent survival benefit for BRCA mutation carriers following BRRM, CM, and
RRSO [2, 3, 5]. Numerous factors, including mutation type, age at time of surgery, and
type/combination of risk-reducing procedure performed, appear to play a role in the ultimate
benefits offered by these surgeries. Surgeons and the treatment team must carefully weigh
risk/benefit decisions with patients prior to making treatment recommendations in the BRCAmutation population.
References
1.
De Felice F, Marchetti C, Musella A et al. Bilateral Risk-Reduction Mastectomy in BRCA1
and BRCA2 Mutation Carriers: A Meta-analysis. Ann Surg Oncol 2015.
2.
Metcalfe K, Gershman S, Ghadirian P et al. Contralateral mastectomy and survival after
breast cancer in carriers of BRCA1 and BRCA2 mutations: retrospective analysis. BMJ 2014; 348:
g226.
3.
Evans DG, Ingham SL, Baildam A et al. Contralateral mastectomy improves survival in
women with BRCA1/2-associated breast cancer. Breast Cancer Res Treat 2013; 140: 135-142.
4.
Hartmann LC, Sellers TA, Schaid DJ et al. Efficacy of bilateral prophylactic mastectomy in
BRCA1 and BRCA2 gene mutation carriers. J Natl Cancer Inst 2001; 93: 1633-1637.
5.
Domchek SM, Friebel TM, Singer CF et al. Association of risk-reducing surgery in BRCA1
or BRCA2 mutation carriers with cancer risk and mortality. JAMA 2010; 304: 967-975.
6.
Hooker GW, King L, Vanhusen L et al. Long-term satisfaction and quality of life following
risk reducing surgery in BRCA1/2 mutation carriers. Hered Cancer Clin Pract 2014; 12: 9.