Does Prophylactic Salpingo-Oophorectomy Improve Survival for Women with Invasive BRCA1/2 Breast Cancer?
BACKGROUND AND PURPOSE:
Martelli et al. (JAMA Surgery, 2023) assessed the association of prophylactic salpingo-oophorectomy (PSO) and prophylactic mastectomy (PM) with prognosis after quadrantectomy or mastectomy as primary treatment for patients with BRCA1 or BRCA2 breast cancer
Retrospective cohort study
Patients followed prospectively from genetic testing after undergoing surgery for breast cancer
Italian National Cancer Institute in Milan
Patients with invasive breast cancer treated surgically between 1972 and 2019 and who carried a pathogenic BRCA1 or BRCA2 gene variant
Both PSO and PM
Overall survival was measured using Kaplan-Meier method
Crude cumulative incidence of breast cancer–specific mortality | Ipsilateral breast tumor recurrence (IBTR) | Contralateral breast cancer | Ovarian cancer | Ovarian cancer–specific mortality
Median age at initial surgery: 40.0 (IQR, 34.0 to 46.0) years
PSO was associated with a significantly reduced risk of death
Hazard ratio (HR) 0.40 (95% CI, 0.25 to 0.64) | P<0.001
This risk reduction was most pronounced for the following
PSO 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
PSO reduces the risk of death for patients who undergo resection for invasive BRCA1/2 breast cancer
The authors state
We conclude that for patients carrying a BRCA1 or BRCA2 variant undergoing breast cancer surgery, PSO should be performed as early as possible, particularly for those with the BRCA1 variant, to reduce overall mortality
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