Risk-Reducing Surgery Linked to Survival in Young BRCA Carriers

In this interview, Eva Blondeaux, MD, University of Genova, Italy, discusses findings from a large international study published in The Lancet Oncology examining risk-reducing surgery in young BRCA carriers with a prior history of breast cancer. Dr. Blondeaux explains the complex nature of counseling this high-risk population and how the study provides needed clarity on the survival benefits of risk-reducing mastectomy and salpingo-oophorectomy. The results showed both procedures were independently associated with improved survival, particularly for BRCA1 carriers. These findings aim to support evidence-based counseling and informed decision-making.

Transcript

What motivated you and your team to focus specifically on young BRCA carriers with prior breast cancer, and what clinical gap were you hoping to address with this study?

Dr. Blondeaux: We know that the counselling of these patients of young BRCA carriers with prior history of breast cancer can be my quite complex, especially when we have to counsel patients regarding risk-reducing surgeries such as risk-reducing mastectomy and risk-reducing salpingo-oophorectomy.

Because we have to take into account different factors. We have to balance the risk of relapse of these patients with their lack clear data regarding counselling of these patients on the impact of risk-reducing surgeries. And we also have to take, obviously, into account patients’ preferences and the impact of this surgery on the reproductive plans, quality of life, and other factors.

So because of the difficulty of this counselling, our aim is to provide the evidence on the topic to help clinicians to counsel these patients and help the counselling.

Your findings showed that both RRM and RRSO were independently associated with improved survival. Were you surprised by the strength or consistency of these associations across different subgroups?

Dr. Blondeaux: Prior studies indicated that …  Prior studies provided conflicting results, so we were not really able to draw solid conclusion on the topic. This is why we did this study, and we firstly demonstrated that risk-reducing mastectomy and risk-reducing salpingo-oophorectomy were independently associated with survival. But we saw this association even after adjusting for all the potential confounding.

So we believe that our results are robust in helping the counselling of these patients. We demonstrated that risk-reducing mastectomy is independently associated with survival if compared in both BRCA1 and BRCA2 carriers. And we know that both BRCA1 and -2 carriers have high risk of developing a second breast cancer after the prior one.

While for risk-reducing salpingo-oophorectomy, this association with survival were more pronounced in BRCA1 carriers compared to BRCA2. But we know that for BRCA1 carriers, the risk of developing ovarian cancer is higher, so this is one of the possible explanations for our findings.