Skip to main content

Advertisement

SpringerLink
Log in

Comparison of Outcomes Between BRCA Pathogenic Variant Carriers Undergoing Breast-Conserving Surgery Versus Mastectomy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Although outcomes are similar following breast-conserving surgery (BCS) or mastectomy among sporadic breast cancer patients, data are mixed for women with a germline BRCA mutation. We sought to compare outcomes among a modern cohort of BRCA mutation carriers undergoing BCS versus mastectomy.

Methods

Women with a BRCA mutation and an index breast cancer from 2006–2015 were retrospectively identified from institutional databases. Factors, including date of genetic testing, clinicopathologic details, and treatment characteristics, were identified. Subsequent locoregional recurrence (LRR), distant recurrence, contralateral breast cancer (CBC), breast cancer-specific survival (BCSS), and overall survival (OS) events were compared between groups.

Results

A total of 395 BRCA mutation carriers with 424 cancers were identified. Surgical treatment included BCS for 99 cancers and mastectomy for 325 cancers. Patients choosing mastectomy were more likely to have bilateral breast cancer, be younger/premenopausal, and be aware of their genetic status before surgery, and were less likely to receive radiation therapy (p < 0.001). At 7.9 years median follow-up, LRR, distant recurrence, BCSS, and OS rates did not differ between groups. CBC occurred in 5 versus 0 women treated with unilateral versus bilateral surgery, respectively, resulting is a 10-year estimated CBC risk of 14% among unilateral breast surgery patients (p < 0.001).

Conclusions

With nearly 8 years follow-up, we report no difference in LRR, BCSS, and OS among BRCA mutation carriers who underwent BCS or mastectomy; however, we report a higher incidence of CBC among those undergoing unilateral breast surgery. These data support BCS as an option for BRCA mutation carriers willing to continue high-risk screening.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Antoniou A, Pharoah PD, Narod S, et al. Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case Series unselected for family history: a combined analysis of 22 studies. Am J Hum Genet. 2003;72(5):1117–30.

    Article  CAS  Google Scholar 

  2. Kuchenbaecker KB, Hopper JL, Barnes DR, et al. Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA. 2017;317(23):2402–16.

    Article  CAS  Google Scholar 

  3. Dorling L, Carvalho S, Allen J, et al. Breast cancer risk genes - association analysis in more than 113,000 women. N Engl J Med. 2021;384(5):428–39.

    Article  CAS  Google Scholar 

  4. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–41.

    Article  Google Scholar 

  5. Davey MG, Davey CM, Ryan EJ, Lowery AJ, Kerin MJ. Combined breast conservation therapy versus mastectomy for BRCA mutation carriers - a systematic review and meta-analysis. Breast. 2021;56:26–34.

    Article  CAS  Google Scholar 

  6. Gilbert E, Zabor EC, Stempel M, Mangino D, Heerdt A, Pilewskie M. Differences among a modern cohort of BRCA mutation carriers choosing bilateral prophylactic mastectomies compared to breast surveillance. Ann Surg Oncol. 2017;24(10):3048–54.

    Article  Google Scholar 

  7. Haffty BG, Harrold E, Khan AJ, et al. Outcome of conservatively managed early-onset breast cancer by BRCA1/2 status. Lancet. 2002;359(9316):1471–7.

    Article  Google Scholar 

  8. Kirova YM, Stoppa-Lyonnet D, Savignoni A, Sigal-Zafrani B, Fabre N, Fourquet A. Risk of breast cancer recurrence and contralateral breast cancer in relation to BRCA1 and BRCA2 mutation status following breast-conserving surgery and radiotherapy. Eur J Cancer. 2005;41(15):2304–11.

    Article  Google Scholar 

  9. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227–32.

    Article  Google Scholar 

  10. Howell A, Ribeiro G, Swindell R. Effects of radiotherapy and surgery in early breast cancer an overview of the randomized trials. N Engl J Med. 1995;333(22):1444–55.

    Article  Google Scholar 

  11. Chiba A, Hoskin TL, Hallberg EJ, et al. Impact that timing of genetic mutation diagnosis has on surgical decision making and outcome for BRCA1/BRCA2 mutation carriers with breast cancer. Ann Surg Oncol. 2016;23(10):3232–8.

    Article  Google Scholar 

  12. Robson M, Levin D, Federici M, et al. Breast conservation therapy for invasive breast cancer in Ashkenazi women with BRCA gene founder mutations. J Natl Cancer Inst. 1999;91(24):2112–7.

    Article  CAS  Google Scholar 

  13. Pierce LJ, Phillips KA, Griffith KA, et al. Local therapy in BRCA1 and BRCA2 mutation carriers with operable breast cancer: comparison of breast conservation and mastectomy. Breast Cancer Res Treat. 2010;121(2):389–98.

    Article  Google Scholar 

  14. Fisher B, Jeong JH, Anderson S, Wolmark N. Treatment of axillary lymph node-negative, estrogen receptor-negative breast cancer: updated findings from national surgical adjuvant breast and bowel project clinical trials. J Natl Cancer Inst. 2004;96(24):1823–31.

    Article  Google Scholar 

  15. Metcalfe K, Gershman S, Lynch HT, et al. Predictors of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. Br J Cancer. 2011;104(9):1384–92.

    Article  CAS  Google Scholar 

  16. Ye F, Huang L, Lang G, et al. Outcomes and risk of subsequent breast events in breast-conserving surgery patients with BRCA1 and BRCA2 mutation. Cancer Med. 2020;9(5):1903–10.

    Article  CAS  Google Scholar 

  17. Elezaby M, Lees B, Maturen KE, et al. BRCA mutation carriers: breast and ovarian cancer screening guidelines and imaging considerations. Radiology. 2019;291(3):554–69.

    Article  Google Scholar 

  18. Davey MG, Davey CM, Ryan ÉJ, Lowery AJ, Kerin MJ. Combined breast conservation therapy versus mastectomy for BRCA mutation carriers—a systematic review and meta-analysis. Breast. 2021;56:26–34.

    Article  CAS  Google Scholar 

  19. Cao W, Xie Y, He Y, et al. Risk of ipsilateral breast tumor recurrence in primary invasive breast cancer following breast-conserving surgery with BRCA1 and BRCA2 mutation in China. Breast Cancer Res Treat. 2019;175(3):749–54.

    Article  CAS  Google Scholar 

  20. 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;348:226.

    Article  Google Scholar 

Download references

Acknowledgments

The preparation of this study was funded in part by NIH/NCI Cancer Center Support Grant No. P30CA008748 to Memorial Sloan Kettering Cancer Center, and this study was presented in poster format at the 2021 Society of Surgical Oncology International Conference on Surgical Cancer Care, March 18–19, 2021.

Author information

Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Sarah Shubeck MD, MS, Alexandra S. Heerdt MD, MPH & Melissa L. Pilewskie MD

  2. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Varadan Sevilimedu MBBS, DrPH

  3. Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    Elizabeth Berger MD, MS

  4. Yale Comprehensive Cancer Center, New Haven, CT, USA

    Elizabeth Berger MD, MS

  5. Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Mark Robson MD

Authors
  1. Sarah Shubeck MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Varadan Sevilimedu MBBS, DrPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth Berger MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mark Robson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alexandra S. Heerdt MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Melissa L. Pilewskie MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Melissa L. Pilewskie MD.

Ethics declarations

Disclosure

The authors have no conflict of interest disclosures to report.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shubeck, S., Sevilimedu, V., Berger, E. et al. Comparison of Outcomes Between BRCA Pathogenic Variant Carriers Undergoing Breast-Conserving Surgery Versus Mastectomy. Ann Surg Oncol 29, 4706–4713 (2022). https://doi.org/10.1245/s10434-022-11756-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-022-11756-1

Search

Navigation