Does Risk-Reducing Surgery Benefit Young Breast Cancer Survivors with BRCA Mutations?

For carriers of BRCA1 or BRCA2 mutations, we've long known that bilateral salpingo-oophorectomy (BSO) and bilateral mastectomy reduce cancer risk in those organs. Similarly, for patients with BRCA mutations who develop breast cancer and undergo risk-reducing BSO (RRBSO), breast cancer–related survival is improved. How about overall survival? Researchers retrospectively studied an international cohort of >5000 young patients (≤40 years) who received a diagnosis of stage I–III breast cancer from 2000 to 2020.

Patients could have undergone breast-conserving surgery or mastectomy as primary surgical therapy for the initial breast cancer. Overall, 64% of patients were BRCA1 pathogenic variant carriers, 51% had node-negative disease, and 46% had hormone-receptor–positive disease; 55% underwent risk-reducing mastectomy (RRM), 53% underwent RRBSO, and 34% underwent both.

Median follow-up was 8 years. Patients who underwent RRM had significantly longer estimated overall survival at 20 years after breast cancer diagnosis than those who did not undergo RRM (average,17.9 vs. 16.7 years). RRBSO was also associated with a significant overall survival benefit compared with no RRBSO (average, 17.7 vs. 16.7 years).