Abstract
Simple SummaryIn this study we report the outcome of salvage mastectomy and reconstruction in 11 BRCA mutation carrier patients that participated in a clinical trial of prophylactic contralateral breast irradiation and suffered reoccurrences of breast cancer in either the ipsilateral or contralateral breast or elected to have the procedure for risk reduction. Patients’ satisfaction and physicians’ assessment of the cosmetic outcome were not inferior for previously irradiated compared to non-irradiated breasts. These results are encouraging and support continuing research as well as a discussion of risk-reduction alternatives besides mastectomy, including prophylactic breast irradiation, in BRCA1/2 mutation carriers.Risk-reducing mastectomy (RRM) is often advocated for BRCA1/2 mutation carriers who face a heightened lifetime risk of breast cancer. However, many carrier patients seek alternative risk-reducing measures. In a phase II nonrandomized trial, we previously reported that prophylactic irradiation to the contralateral breast among BRCA carriers undergoing breast-conserving treatment significantly reduced subsequent contralateral breast cancer. Herein, we report the outcome of salvage mastectomy and reconstruction in 11 patients that suffered reoccurrences of breast cancer in either the ipsilateral or contralateral breast or elected to have the procedure for risk reduction during the eight-year follow-up period. Patients’ satisfaction with the procedure and physicians’ assessment of the cosmetic outcome were not inferior for previously irradiated compared to non-irradiated breasts. Although the numbers are small, the results are encouraging and sustain hope in a challenging population. Our findings support continuing research as well as a discussion of risk-reduction alternatives besides mastectomy, including prophylactic breast irradiation, in BRCA1/2 mutation carriers.
Highlights
BRCA mutations are prevalent in Israel, as 2.5% of the Ashkenazi Jewish population, which comprises about 50% of Jewish Israelis, carry a specific founder mutation in BRCA1 or BRCA2
The overall lifetime risk of breast cancer for women carrying a BRCA1/2 mutation is between 50% and 80%, while the lifetime risk for ovarian cancer is 15% to 40% [14]
While risk-reducing mastectomy (RRM) markedly decreases the occurrence of breast cancer in BRCA mutation carriers, its effect on survival is less apparent [16], especially in patients who already developed breast cancer and face the hazard of systemic recurrence [17]
Summary
BRCA mutations are prevalent in Israel, as 2.5% of the Ashkenazi Jewish population, which comprises about 50% of Jewish Israelis, carry a specific founder mutation in BRCA1 or BRCA2. 20% of young-age (
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