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May 2024 | George M. Pikler, M.D., Ph.D., FACP, Lead Oncology Advocate N1X10

Risk-Reducing Mastectomy Reduces the Risk of Breast Cancer

Women who have inherited BRCA1/2 and PLB2 pathogenic genetic variants have an increased lifetime risk of breast cancer. Research has shown that a risk-reducing mastectomy (RRM) for surgical prevention may reduce the risk of breast cancer by 90%. RRM refers to surgical removal of the breasts in the absence of malignancy to reduce breast cancer risk in these women. RRM is synonymous with prophylactic mastectomy and is further specified as either bilateral or contralateral. Bilateral RRM (BRRM) refers to removal of both breasts in asymptomatic women, while contralateral RRM (CRRM) refers to removal of the unaffected breast when bilateral mastectomy is performed for the management of unilateral breast cancer.

Asymptomatic carriers of these high-risk germline variants should be informed that screening (mammograms and breast MRI imaging) and chemoprevention are potential alternatives to BRRM. Women who have received chest wall radiotherapy before age 30 may wish to consider BRRM to lower breast cancer risk or CRRM to reduce risk of a new primary cancer in the opposite breast if diagnosed with unilateral breast cancer.

For asymptomatic carriers of moderate-risk variants, BRRM is generally not recommended and screening and chemoprevention are preferred means of lowering breast cancer risk. Additionally, CRRM is not generally indicated for carriers of moderate-risk variants who are diagnosed with unilateral breast cancer.

In a recent study, investigators examined how risk-reducing mastectomy may affect the rate of mortality in 1,600 female patients with pathogenic BRCA1 or BRCA2 variants but no breast cancer diagnoses. They noted that about 50% of the patients underwent risk-reducing mastectomy. After a follow-up of 6 years, the investigators discovered 20 cases of breast cancer and two deaths in the risk-reducing mastectomy group, and 100 cases of breast cancer and seven deaths in the control group. Additionally, risk-reducing mastectomy decreased the risk of breast cancer incidence by 80%, and the risk of dying from breast cancer within 15 years of the procedure was less than 1%. According to this study, women with a BRCA1 or BRCA2 pathogenic variant, RRM reduces the risk of breast cancer, and the probability of dying of breast cancer is low.

British Journal of Cancer. 2024, 130: 269-274
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Erica Cross, PA

PA

Erica is a board certified Physician Assistant. She obtained her Master’s degree in Physician Assistant studies from Our Lady of the Lake College in Baton Rouge, LA. She began practicing in 2011 and has worked clinically in Orthopedics and Dermatology. The majority of her career has been spent in a Dermatology practice where she assisted in Mohs surgery, treating various types of skin cancer. She also teaches in the medical simulation department at the University of South Alabama and enjoys every aspect of medical education.