Prevention: Risk-Reducing Surgery

  • BBSG – Brazilian Breast Study Group


Risk-reducing surgical procedures are also wrongly referred to as “prophylactic surgery.” This second term should be avoided as it suggests the false idea that there is total cancer prevention. The surgical procedures are bilateral prophylactic mastectomy and bilateral salpingo-oophorectomy. These are strategies that can be used in patients at high risk for breast cancer, but their role is much better defined in women with deleterious mutations associated with breast cancer, especially BRCA-1 and BRCA-2. These procedures have high complexity and considerable risk of complications and should be reserved for exceptional situations and after careful evaluation of risks and benefits.

Recommended Reading

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    Boughey J, Hoskin TL, Degnim AC, et al. Contralateral prophylactic mastectomy is associated with a survival advantage in high-risk women with a personal history of breast cancer. Ann Surg Oncol. 2010;17:2702–9. A retrospective study evaluating the role of contralateral risk-reducing mastectomy in high risk women with breast cancer EC I and II. After 17 years, there was an increase in SLD and SG in the group submitted to contralateral RRM.CrossRefGoogle Scholar
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    Domcheck SM, Friebel TM, Singer CF, et al. Association of risk-reducing surgery in BRCA 1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA. 2010;304:967–75. Evaluation of 2482 women with BRCA mutation 1 and 2, 15% of whom were submitted to RRM and 40% were submitted to SOB. No patient undergoing RRM developed breast cancer, versus 7% in the non-RRM group, and SOB was associated with reduction of all-cause mortality, reduction of specific mortality for breast cancer, and reduction of specific mortality for ovarian cancer.CrossRefGoogle Scholar
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    Heemskerk-Gerritsen BA, Rookus MA, Aalfs CM, et al. Improved overall survival after contralateral risk-reducing mastectomy in BRCA ½ mutation carriers with a history of unilateral breast cancer: a prospective analysis. Int J Cancer. 2015;136:668–77. A study with 583 women with cancer and BRCA mutation was evaluated at 11-year follow-up. The incidence of breast cancer was 2% in the contralateral RRM group versus 19% in the mastectomy only group, and there was a 50% reduction in mortality in the contralateral RRM group.PubMedGoogle Scholar
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    Lostumbo L, Carbine NE, Wallace J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev. 2010;(10, 11):CD002748. Systematic review written initially in 2004 and revised in 2010. It evaluates the main studies on bilateral and contralateral mastectomy.Google Scholar
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    Metcalfe K, Gershman S, Ghadirian P. Contralateral mastectomy and survival after breast cancer in carriers of BRCA 1 and BRCA 2 mutations: retrospective analysis. BMJ. 2014;348. A study with women at stage I and II breast cancer and mutation in BRCA 1 and 2, submitted to unilateral surgery. In this sample, the risk of developing contralateral cancer was 40% in 10 years and the factors associated with the reduction of this risk were the use of tamoxifen and oophorectomy. The risk of these women who already had breast cancer to develop ovarian cancer was 12.7% ratio for BRCA 1 mutation carriers and 6.8% for BRCA 2 mutation.Google Scholar
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    Rebbeck TR, Kauff ND, Domchek SM. Meta-analysis of risk reduction estimates associated with risk-reducing salpingooophorectomy in BRCA1 or BRCA2 mutation carriers. J Nat Cancer Inst. 2009;101(2):80–7. A meta-analysis of 10 studies on the benefit of SOB in reducing breast cancer risk.The benefit was observed in all mutated patients: BRCA-1 (HR: 0.47 CI: 0.35–0.64) and BRCA-2 (HR: 0.47; CI: 0.265–0.85).CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • BBSG – Brazilian Breast Study Group
    • 1
  1. 1.BBSGSao PauloBrazil

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