Is Breast Conserving Surgery Efficacious in Breast Cancer Patients with BRCA1 or BRCA2 Germline Mutation?

Abstract

Selman Emiroglu,1 Enver Özkurt,2 Neslihan Cabıoglu,1 Abdullah Igci,3 Pinar Saip,4 Hulya Yazici,4 Tolga Ozmen,5 Vahit Ozmen,1 Mahmut Muslumanoglu,1 Mustafa Tukenmez1 1Breast Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; 2Department of Surgery, Ozel Basari Hospital, Istanbul, Turkey; 3Department of Surgery, American Hospital, Istanbul, Turkey; 4Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey; 5Division of Gastrointestinal and Oncologic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USACorrespondence: Selman Emiroglu, Breast Surgery Service, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, 34390, Turkey, Email [email protected]: The optimal surgical therapy for newly diagnosed breast cancer with germline mutations in susceptibility genes is still uncertain for many physicians. In this study, we aimed to determine the efficacy of breast conserving surgery (BCS) in breast cancer patients with BRCA1 or BRCA2 mutation by assessing its outcomes and locoregional recurrence (LR) rates.Materials and Methods: Seventy-five patients operated with BCS or mastectomy for breast cancer between 2006 and 2017 and had BRCA1 or BRCA2 mutation were included in the study. Effects of the performed breast surgery and clinicopathological characteristics on surgical outcomes, LR rates and survival were analyzed with showing the distribution of BRCA1 and BRCA2 germline mutations.Results: The median age of the patients was 42 years (20– 77). BRCA1 mutations were found in 46 (61.3%) patients and BRCA2 mutations in 29 (38.7%) patients. Compared to BRCA2 carriers, BRCA1 carriers were more likely to have higher tumor grade (84.8% vs 44.8%; p = 0.001) and non-luminal subtype tumors (67.4% vs 13.8%; p = 0.001). A total of 44 (58.7%) patients underwent unilateral mastectomy and 31 (41.3%) patients underwent BCS. At a median follow-up time of 60 (12– 240) months, LR was observed in 6 patients equally divided in both BCS and mastectomy groups. LR rates were slightly higher after BCS versus mastectomy (9.7% and 6.8%, respectively). Additionally, there were no statistically significant differences in disease-free survival (DFS) and disease-specific survival (DSS) rates after 10 years in the BCS group versus the mastectomy group (p = 0.117 and 0.109, respectively), but in fact, the rates were better in the BCS group.Conclusion: Our findings indicate that BCS may serve as an efficacious alternative to mastectomy for breast cancer patients with BRCA1 or BRCA2 mutation. Additionally, tumor size, lymph node positivity, and TNM stage should be taken into consideration for a better surgical decision-making.Keywords: BRCA1 or BRCA2 germline mutation, breast conserving surgery, surgical decision, locoregional recurrence

Keywords

• brca1 or brca2 germline mutation
• breast conserving surgery
• surgical decision
• locoregional recurrence.