Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Apr:56:26-34.
doi: 10.1016/j.breast.2021.02.001. Epub 2021 Feb 4.

Combined breast conservation therapy versus mastectomy for BRCA mutation carriers - A systematic review and meta-analysis

M G Davey  1 , C M Davey  2 , É J Ryan  3 , A J Lowery  4 , M J Kerin  4
Affiliations
Meta-Analysis

Combined breast conservation therapy versus mastectomy for BRCA mutation carriers - A systematic review and meta-analysis

M G Davey et al. Breast. 2021 Apr.

Abstract

Background: The non-inferiority of combined breast conservation surgery (BCS) and radiotherapy (breast conservation therapy or BCT) compared to mastectomy in sporadic breast cancer cases is well recognised. Uncertainty remains regarding optimal surgical practice in BRCA mutation carriers.

Aims: To evaluate the oncological safety of combined BCT versus mastectomy in BRCA mutation carriers following breast cancer diagnosis.

Methods: A systematic review was performed as per PRISMA and MOOSE guidelines. Observational studies comparing BCS and mastectomy in BRCA carriers were identified. Dichotomous variables were pooled as odds ratios (OR) using the Mantel-Haenszel method. Log hazard ratios (lnHR) for locoregional recurrence (LRR), contralateral breast cancer, disease-free and overall survival and their standard errors were calculated from Kaplan-Meier or cox-regression analyses and pooled using the inverse variance method.

Results: Twenty three studies of 3807 patients met inclusion criteria; 2200 (57.7%) were BRCA1 and 1212 (31.8%) were BRCA2 carriers. Median age at diagnosis was 41 years with 96 months follow up. BCS was performed on 2157 (56.7%) while 1408 (41.5%) underwent mastectomy. An increased risk of LRR was observed in patients treated with BCS (HR:4.54, 95% Confidence Interval: 2.77-7.42, P < 0.001, heterogeneity (I2) = 0%). However, the risks of contralateral breast cancer (HR:1.51, 95%CI: 0.44-5.11, P = 0.510, I2 = 80%), disease recurrence (HR:1.16, 95%CI: 0.78-1.72, P = 0.470, I2 = 44%), disease-specific recurrence (HR:1.58, 95%CI: 0.79-3.15, P = 0.200, I2 = 38%) and death (HR:1.10, 95%CI: 0.72-1.69, P = 0.660, I2 = 38%) were equivalent for combined BCT and mastectomy.

Conclusions: Survival outcomes following combined BCT is comparable to mastectomy in BRCA carriers. However, the risk of LRR is increased. Patient counselling should be tailored to incorporate these findings.

Keywords: BRCA mutations; Breast cancer; Genetics; Surgical oncology.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
PRISMA flow diagram detailing the systematic search process.
Fig. 2
Fig. 2
Forest plots illustrating (A) locoregional recurrence, (B) contralateral breast cancer, (C) disease-free survival, (D) disease-specific survival, and (E) overall survival for those undergoing BCS and mastectomy.
Fig. 3
Fig. 3
Forest plots illustrating 5-year (A) locoregional recurrence, (B) disease-free survival, (C) disease-specific survival, and (D) overall survival for those undergoing BCS and mastectomy.
Fig. 4
Fig. 4
Forest plots illustrating 10-year (A) locoregional recurrence, (B) disease-free survival, (C) disease-specific survival, and (D) overall survival for those undergoing BCS and mastectomy.
Fig. 5
Fig. 5
Forest plots illustrating 15-year (A) locoregional recurrence, (B) disease-free survival, (C) disease-specific survival, and (D) overall survival for those undergoing BCS and mastectomy.
See this image and copyright information in PMC

References

    1. DeSantis C.E., Ma J., Goding Sauer A., Newman L.A., Jemal A. Breast cancer statistics, 2017, racial disparity in mortality by state. CA A Cancer J Clin. 2017;67(6):439–448. - PubMed
    1. Mahdavi M., Nassiri M., Kooshyar M.M., Vakili-Azghandi M., Avan A., Sandry R. Hereditary breast cancer; Genetic penetrance and current status with BRCA. J Cell Physiol. 2019;234(5):5741–5750. - PubMed
    1. Kuchenbaecker K.B., Hopper J.L., Barnes D.R., Phillips K.A., Mooij T.M., Roos-Blom M.J. Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. Jama. 2017;317(23):2402–2416. - PubMed
    1. Gabai-Kapara E., Lahad A., Kaufman B., Friedman E., Segev S., Renbaum P. Population-based screening for breast and ovarian cancer risk due to BRCA1 and BRCA2. Proc Natl Acad Sci U S A. 2014;111(39):14205–14210. - PMC - PubMed
    1. Antoniou A., Pharoah P.D., Narod S., Risch H.A., Eyfjord J.E., Hopper J.L. Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case Series unselected for family history: a combined analysis of 22 studies. Am J Hum Genet. 2003;72(5):1117–1130. - PMC - PubMed