Breast-Conserving Surgery in BRCA Mutation Carriers: A Paradigm Shift Toward Individualized, Multidisciplinary Care

Area of Science:

• Oncology
• Surgical Oncology
• Genetics

Background:

• BRCA1/2 mutations pose unique challenges in breast cancer treatment, historically favoring mastectomy.
• Advances in multimodal therapy are shifting treatment paradigms for BRCA carriers.

Purpose of the Study:

• To review current evidence on breast-conserving surgery (BCS) versus mastectomy for BRCA-mutated breast cancer.
• To evaluate oncologic outcomes, recurrence risks, and patient-centered benefits of BCS.

Main Methods:

• Narrative review synthesizing data from meta-analyses, retrospective cohorts, and multicenter studies.
• Analysis of oncologic equivalence, local recurrence rates, survival data, and psychosocial outcomes.

Main Results:

• BCS combined with radiotherapy and systemic therapy shows oncologic equivalence to mastectomy.
• While BCS may have higher local recurrence, overall survival is comparable.
• BCS is associated with improved body image, psychosocial well-being, and quality of life, particularly for younger patients.

Conclusions:

• BCS is a viable and recommended option for selected BRCA carriers with breast cancer.
• Individualized surgical planning balancing oncologic safety, systemic treatments, and psychosocial factors is crucial.
• Optimized systemic therapies and fertility preservation options further support BCS in BRCA carriers.