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Breast Conserving Surgery for BRCA Mutation Carriers-A Systematic Review.

Michael Co¹, Thomas Liu¹, Jason Leung¹

¹Division of Breast Surgery, University of Hong Kong, Hong Kong.

Clinical Breast Cancer

|March 8, 2020

Summary

Breast conserving surgery (BCS) shows comparable survival to mastectomy for BRCA mutation carriers but has higher recurrence rates. BCS can be an option with informed counseling regarding breast cancer risks.

Keywords:

Breast neoplasms Hereditary breast and ovarian cancer syndrome Mastectomy Segmental mastectomy Survival

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Area of Science:

Oncology
Surgical Oncology
Genetics

Background:

Breast conserving surgery (BCS) is standard for breast cancer, but its safety in BRCA mutation carriers is debated.
BRCA mutations significantly increase breast cancer risk, influencing treatment decisions.

Purpose of the Study:

To systematically review evidence comparing BCS and mastectomy in BRCA mutation carriers.
To evaluate the oncologic safety and survival outcomes of BCS versus mastectomy.

Main Methods:

Systematic review of Medline, EMBASE, CINAHL, and Cochrane databases.
Qualitative synthesis of 18 retrieved studies following PRISMA guidelines.
No randomized controlled trials were identified.

Main Results:

Overall survival at 5, 10, and 15 years was comparable between BCS and mastectomy.
Ipsilateral breast cancer recurrence rates were significantly higher with BCS (5y: 8.2%, 10y: 15.5%, 15y: 23%) versus mastectomy (5y: 3.4%, 10y: 4.9%, 15y: 6.4%).
BCS did not show adverse short- or long-term survival outcomes.

Conclusions:

BCS is associated with increased ipsilateral breast cancer recurrence in BRCA mutation carriers.
Despite higher recurrence, BCS does not negatively impact overall survival.
BCS should be considered a viable surgical option for BRCA carriers with appropriate preoperative counseling on risks.