Sufferers with germline BRCA mutations who had been recognized with breast most cancers at or earlier than age 40 and who underwent a bilateral risk-reducing mastectomy (RRM) and/or a risk-reducing salpingo-oophorectomy (RRSO) had decrease charges of recurrence, secondary breast and/or ovarian malignancies, and demise than those that didn’t endure these surgical procedures, in response to outcomes offered on the San Antonio Breast Most cancers Symposium (SABCS), held December 10-13, 2024.
“The advantages of RRM and RRSO have been proven for BRCA-mutation carriers and not using a prior historical past of most cancers, however their affect for BRCA-mutation carriers with a historical past of early-onset breast most cancers is much less clear,” stated presenter Matteo Lambertini, MD, PhD, an affiliate professor of medical oncology and advisor in medical oncology on the College of Genova-IRCCS Policlinico San Martino Hospital in Genoa, Italy.
Each RRM and RRSO can adversely have an effect on a affected person’s high quality of life and RRSO additionally results in infertility and early menopause, which could be notably tough for BRCA carriers with prior breast most cancers since they aren’t eligible for the hormone substitute therapies that assist mitigate menopause signs, Lambertini defined. “Contemplating the distinctive traits and wishes of this youthful inhabitants, and their excessive danger for secondary malignancies, it’s vital to know how risk-reducing surgical procedures have an effect on affected person outcomes in order that the dangers and advantages of those procedures could be rigorously weighed,” he stated.
To review the affiliation between RRM and/or RRSO and survival outcomes, Lambertini and colleagues carried out an evaluation of the BRCA BCY Collaboration examine, a world, multicenter, retrospective cohort examine of sufferers with germline pathogenic or seemingly pathogenic variants of BRCA who had been recognized with stage 1-3 breast most cancers on the age of 40 or youthful between January 2000 and December 2020.
The evaluation included 5,290 sufferers from 109 establishments throughout 5 continents. Amongst these sufferers, 3,888 underwent at the very least one risk-reducing surgical procedure: 2,910 underwent RRM, 2,782 underwent RRSO, and 1,804 opted for each RRM and RRSO. The remaining 1,402 sufferers didn’t endure both surgical procedure.
The researchers discovered that present process RRM and/or RRSO was related to improved outcomes after a median follow-up of 8.2 years.
Particularly, sufferers who had a RRM had a 35% decrease danger of demise and a 42% decrease danger of breast most cancers recurrence or a second main malignancy. The improved outcomes had been noticed no matter whether or not the germline BRCA mutation was current within the BRCA1 or BRCA2 gene.
Sufferers who underwent a RRSO had a 42% decrease danger of demise and a 32% decrease danger of breast most cancers recurrence or second main malignancy. The advantage of RRSO on general survival assorted by the BRCA gene that was mutated, with a larger survival profit for sufferers with germline mutations in BRCA1 than in BRCA2 (56% vs. 15% decrease danger of demise, respectively). When analyzing by breast most cancers subtype, the researchers discovered that RRSO had the best survival profit for sufferers with triple-negative breast most cancers (56% decrease danger of demise), adopted by hormone receptor-positive breast most cancers (20% decrease danger of demise).
Total survival was related between sufferers who underwent each surgical procedures and people who had just one surgical procedure.
This world examine gives the primary proof that risk-reducing surgical procedures enhance survival outcomes amongst younger BRCA-mutation carriers with a previous historical past of early-onset breast most cancers. We imagine that our findings are vital for bettering the counseling of BRCA-mutation carriers with early-onset breast most cancers on cancer-risk administration methods.”
Matteo Lambertini, MD, PhD, affiliate professor of medical oncology and advisor in medical oncology, College of Genova-IRCCS Policlinico San Martino Hospital
Limitations of the examine embody its retrospective design and the inclusion of sufferers from totally different well being care methods with totally different sources and pointers. As well as, the evaluation contains sufferers handled over a interval of 20 years, throughout which suggestions for germline BRCA testing and for risk-reducing surgical procedures have developed. Additional, the outcomes might have been biased if sufferers perceived to have higher prognosis had been extra prone to have risk-reducing surgical procedures advisable to them.
The examine was supported by the Italian Affiliation for Most cancers Analysis (AIRC) and the European Society for Medical Oncology (ESMO). Lambertini reviews advisory roles for Roche, Lilly, Novartis, AstraZeneca, Pfizer, Seagen, Gilead, MSD, Precise Sciences, Pierre Fabre, and Menarini; speaker honoraria from Roche, Lilly, Novartis, Pfizer, Sandoz, Libbs, Daiichi Sankyo, Takeda, Menarini, and AstraZeneca; journey grants from Gilead, Daiichi Sankyo, and Roche; and analysis funding to his establishment from Gilead.
