Breast cancer prevention in patients with gBRCA-mutated ovarian cancer.

PURPOSE: Ovarian cancer is frequently associated with gBRCA1/2 mutations, which also confer a high lifetime risk of breast cancer in non-affected patients. While risk-reducing salpingo-oophorectomy (RRSO) is established in hereditary breast and ovarian cancer prevention, the recommendation for risk-reducing bilateral mastectomy (RRBM) remains unclear in gBRCA1/2mutovarian cancer patients due to high recurrence rates and limited survival. This study evaluates the preventive strategies of these patients in a real-world setting.

METHODS

This retrospective study included 49 patients with gBRCA1/2mut HGSC treated at the Hereditary Breast and Ovarian Cancer Centre, University Hospital Erlangen, between 2012 and 2024. Clinical, pathological, treatment-related, and genetic data were collected and analyzed from electronic records.

RESULTS

Among 49 patients with gBRCAmut HGSC, 44 out of 49 did not undergo a RRBM during follow-up. Intensified breast cancer surveillance was recommended to 33 patients. Although 19 out of 49 patients were formally recommended a RRBM, only two proceeded with the preventive option. Three additional patients chose the surgery driven by the diagnosis of metachronous breast cancer. 80% of the operations occurred > 60 months after ovarian cancer diagnosis.

CONCLUSIONS

In patients with gBRCA1/2mut and a history of HGSC, RRBM is rarely chosen. Most patients prefer an intensified surveillance program. Due to low metachronous breast cancer rate in follow up care, RRBM seems to be an option just for long-term survivors. Individual patient preferences play a crucial role in the management strategy.