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- Title
Prophylactic Salpingo-Oophorectomy and Survival After BRCA1/2 Breast Cancer Resection.
- Authors
Martelli, Gabriele; Barretta, Francesco; Vernieri, Claudio; Folli, Secondo; Pruneri, Giancarlo; Segattini, Silvia; Trapani, Anna; Carolla, Claudia; Spatti, Gianbattista; Miceli, Rosalba; Ferraris, Cristina
- Abstract
Key Points: Question: Is prophylactic salpingo-oophorectomy (PSO) for patients with surgically resected, pathogenic germline BRCA1 or BRCA2 breast cancer associated with improved overall survival? Findings: This cohort study of 480 consecutive patients with surgically treated BRCA1/2 breast cancer between 1972 and 2019 showed that PSO was significantly associated with improved overall survival compared with no PSO. Meaning: These findings suggest that PSO should be offered to patients with BRCA1/2 breast cancer who undergo surgery, particularly those with the BRCA1 variant, to reduce the risk of death. This cohort study assesses the prognostic outcomes of prophylactic salpingo-oophorectomy after surgical resection of breast cancer for patients carrying the BRCA1 or BRCA2 variant. Importance: Few studies have investigated whether prophylactic salpingo-oophorectomy (PSO) for patients with previously resected breast cancer who carry pathogenic germline BRCA1 or BRCA2 variants is associated with a reduced risk of cancer-specific death. Objective: To assess the association of PSO and prophylactic mastectomy (PM) with prognosis after quadrantectomy or mastectomy as primary treatment for patients with BRCA1 or BRCA2 breast cancer. Design, Setting, and Participants: This retrospective cohort study was performed in a single-institution, tertiary referral center. Consecutive patients with invasive breast cancer treated surgically between 1972 and 2019 were recruited and followed up prospectively after they were found to carry the BRCA1 or BRCA2 gene variant. The data analysis was performed between April 2022 and July 2023. Exposure: Following breast surgery, some patients underwent PSO, PM, or both, whereas others did not. Main Outcomes and Measures: The primary study end point was overall survival as measured by the Kaplan-Meier method. Secondary end points were crude cumulative incidence of breast cancer–specific mortality, ipsilateral breast tumor recurrence (IBTR), contralateral breast cancer, ovarian cancer, and ovarian cancer–specific mortality. Results: Of 480 patients included in the cohort (median age at initial surgery, 40.0 years; IQR, 34.0-46.0 years), PSO was associated with a significantly reduced risk of death (hazard ratio [HR], 0.40; 95% CI, 0.25-0.64; P <.001). This reduction was most evident for patients carrying the BRCA1 variant (HR, 0.35; 95% CI, 0.20-0.63; P =.001), those with triple-negative disease (HR, 0.21; 95% CI, 0.09-0.46; P =.002), and those with invasive ductal carcinoma (HR, 0.51; 95% CI, 0.31-0.84; P =.008). Prophylactic salpingo-oophorectomy was not associated with risk of contralateral breast cancer or IBTR. Initial or delayed PM was associated with a reduced risk of IBTR but not with overall survival or breast cancer–specific mortality. Conclusions: The study findings suggest that PSO should be offered to all patients with BRCA1/2 breast cancer who undergo surgery with curative intent to reduce risk of death. In particular, PSO should be offered to patients with the BRCA1 variant at the time of breast surgery.
- Publication
JAMA Surgery, 2023, Vol 158, Issue 12, p1275
- ISSN
2168-6254
- Publication type
Article
- DOI
10.1001/jamasurg.2023.4770