Breast conserving surgery in BRCA mutation carriers - a systematic review

Abstract

Introduction: Like mastectomy, breast conserving surgery (BCS) is currently the gold standard of surgical treatment for breast cancers in sporadic patients. However, its oncologic safety in BRCA mutation carriers remain controversial; Here we conduct a systematic review to critically evaluate the best evidence from the literature

Methods: A comprehensive review was performed on Medline, EMBASE, CINAHL and Cochrane databases using predefined strategy. Retrieved studies were independently screened and rated for relevance. Data were extracted for qualitative synthesis according to the PRISMA protocol for systematic reviews.

Results: There is no randomized controlled trial that directly compares BCS and mastectomy in BRCA mutation carriers. Out of the 18 studies included in this review, pooled analysis of overall survival (OS) at 5-, 10- and 15-year were comparable between BCS and mastectomy [88.7%, 89.0% and 83.6% in BCS; comparing to 83%, 86.0% and 83.2%, in mastectomy. However, the pooled ipsilateral breast cancer recurrence rates at 5-, 10- and 15- year were higher in the BCS group at 8.2%, 15.5% and 23%; comparing to that of mastectomy at 3.4%, 4.9% and 6.4%.

Conclusion: BCS is associated with higher ipsilateral breast cancer recurrence in BRCA mutation carriers. However, it is not associated with adverse short and long-term survival outcomes. BCS should be offered as an option to BRCA mutation carriers with proper pre-operative counselling.