Risk-reducing salpingo-oophorectomy in patients with gBRCA-mutated breast cancer

Abstract

Purpose

Breast cancer (BC) patients with pathogenic germline BRCA1/2 mutations (gBRCA1/2mut) have a substantially increased risk of ovarian cancer (OC). Risk-reducing bilateral salpingo-oophorectomy (RRSO) remains the only effective preventive strategy. However, data on the utilization and time to RRSO in gBRCAmut BC patients are limited.

Methods

This retrospective study included 148 patients with gBRCA1/2mut BC treated at the Hereditary Breast and Ovarian Cancer Center, University Hospital Erlangen, between 2012 and 2024. Clinical, pathological, treatment-related, and genetic data were collected and analyzed from electronic records. Time to RRSO at date of BC surgery was calculated for all patients, and stratified according guideline recommendations for RRSO, using the Kaplan–Meier method.

Results

In this cohort of 148 patients with gBRCAmut BC, 60.8% harbored a gBRCA1 and 39.2% a gBRCA2 mutation. BC was diagnosed at the mean age of 47.1 years, 73.6% presenting at UICC stage I–II. 47.9% of patients presented with triple-negative BC, 38.4% of patients with hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative BC and 8.9% with HER2-positive BC. 101 patients (68.2%) additionally underwent RRSOs. The 12-month RRSO-free probability was 0.58 (95% CI 0.50–0.68) and the 24-month RRSO-free probability 0.39 (95% CI 0.31–0.49). Occult OC was detected in three patients at the time of RRSO during BC follow-up, four patients without RRSO were diagnosed with OC after BC.

Conclusions

In real-world setting, RRSO is a common prevention in gBRCAmut BC follow-up. The majority of patients undergo surgery within the first two years following a BC diagnosis. Survival outcomes among patients with BC have improved substantially in recent years. Consequently, developing OC in gBRCAmut BC individuals still remains a risk. RRSO should therefore continue to be offered and discussed in accordance with current guidelines, even in the context of a BC diagnosis.