https://doi.org/10.55788/2ecf6b07
Pathogenic variants in BRCA1 and BRCA2, which are found in 3–4% of women with breast cancer, increase the risk of ipsilateral and contralateral breast cancer, as well as the risk of ovarian cancer. For this reason, many women with a BRCA-mutated unilateral breast cancer opt for bilateral mastectomy. However, it is not clear to what extent this operation impacts long-term breast cancer mortality. An international study, initiated at the University of Toronto, thus evaluated the differences in survival by surgical treatment in an international cohort of women with a BRCA1 mutation and unilateral breast cancer. Dr Kelly Metcalfe (Women’s College Research Institute Toronto, Canada) presented the interim results [1].
A total of 2,482 patients with stage I–III, BRCA1-mutated, unilateral breast cancer (mean age 43 years) were enrolled; 34.3% underwent breast-conserving surgery, 46% underwent unilateral mastectomy, and 19.7% underwent bilateral mastectomy.
Among those who had a unilateral mastectomy or breast-conserving surgery, the risk of contralateral breast cancer at 20 years was 27.5%. After experiencing a contralateral cancer, the hazard ratio for breast cancer-related death was 2.22 (95% CI 1.49–3.32; P<0.0001) compared with patients without contralateral breast cancer, regardless of age. Of all patients, 11.5% died of breast cancer during follow-up. The 15-year breast cancer-specific survival in the entire cohort was 82.9%. The survival was 78.7% for those who had a unilateral mastectomy, 86.2% for those who had breast-conserving surgery, and 88.7% for those who had bilateral mastectomies. Age was not correlated to survival.
“What we see from these data is that women with breast cancer with a pathogenic BRCA1 variant who have bilateral mastectomy are significantly less likely to develop contralateral breast cancer. However, bilateral mastectomy is not significantly associated with a reduction in mortality compared with breast-conserving surgery,” concluded Dr Metcalfe. “The cohort will require longer follow-up for definitive results, and additional analyses are ongoing.”
- Metcalfe KA, et al. Surgical treatment of women with breast cancer and a BRCA1 pathologic variant: an international analysis of the impact of bilateral mastectomy on survival. GS02-04, SABCS 2023, 5–9 December, San Antonio, TX, USA.
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Table of Contents: SABCS 2023
Featured articles
Olaparib maintenance has favourable safety profile in TNBC
Exercise programme improves quality of life for patients with metastatic breast cancer
Living With & After Breast Cancer
Exercise programme improves quality of life for patients with metastatic breast cancer
Fast menstrual resumption after interruption of endocrine therapy
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Early Breast Cancer
Highest benefit of neoadjuvant nivolumab in breast tumours with high PD-L1 expression and/or low ER expression
(More) axillary surgery does not influence long-term recurrence
Neoadjuvant chemotherapy may help patients skip regional nodal irradiation
No radiotherapy after breast-conserving surgery is safe in selected younger patients
HER2-Positive Breast Cancer
Tucatinib improves PFS in metastatic, HER2-positive breast cancer
OS benefit of adjuvant T-DM1 in early breast cancer with residual disease after neoadjuvant therapy
Atezolizumab improves pCR in HER2-positive early breast cancer
HR-Positive/HER2-Negative Breast Cancer
Adjuvant ribociclib improves IDFS in early breast cancer
Addition of inavolisib to palbociclib and fulvestrant reduces risk of progression
Endocrine therapy response provides information on need of adjuvant chemotherapy
monarchE: No predictive biomarkers revealed with molecular profiling
No predictive biomarkers found in PALLAS
Triple-Negative Breast Cancer
Bilateral mastectomy and breast-conserving surgery have equal impact on breast cancer-specific mortality in pathogenic BRCA1 carriers
Olaparib maintenance has favourable safety profile in TNBC
High pCR with neoadjuvant nivolumab/chemotherapy in stage I–II TNBC
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