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Review
. 2023 Feb 10;12(4):1422.
doi: 10.3390/jcm12041422.

Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review

Serena Bertozzi  1   2 , Ambrogio P Londero  2   3 , Anjeza Xholli  4 , Guglielmo Azioni  4 , Roberta Di Vora  1 , Michele Paudice  5   6 , Ines Bucimazza  7 , Carla Cedolini  1   2 , Angelo Cagnacci  3   4
Affiliations
Review

Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review

Serena Bertozzi et al. J Clin Med. .

Abstract

This narrative review aims to clarify the role of breast and gynecological risk-reduction surgery in BRCA mutation carriers. We examine the indications, contraindications, complications, technical aspects, timing, economic impact, ethical issues, and prognostic benefits of the most common prophylactic surgical options from the perspectives of a breast surgeon and a gynecologist. A comprehensive literature review was conducted using the PubMed/Medline, Scopus, and EMBASE databases. The databases were explored from their inceptions to August 2022. Three independent reviewers screened the items and selected those most relevant to this review's scope. BRCA1/2 mutation carriers are significantly more likely to develop breast, ovarian, and serous endometrial cancer. Because of the Angelina effect, there has been a significant increase in bilateral risk-reducing mastectomy (BRRM) since 2013. BRRM and risk-reducing salpingo-oophorectomy (RRSO) significantly reduce the risk of developing breast and ovarian cancer. RRSO has significant side effects, including an impact on fertility and early menopause (i.e., vasomotor symptoms, cardiovascular disease, osteoporosis, cognitive impairment, and sexual dysfunction). Hormonal therapy can help with these symptoms. Because of the lower risk of developing breast cancer in the residual mammary gland tissue after BRRM, estrogen-only treatments have an advantage over an estrogen/progesterone combined treatment. Risk-reducing hysterectomy allows for estrogen-only treatments and lowers the risk of endometrial cancer. Although prophylactic surgery reduces the cancer risk, it has disadvantages associated with early menopause. A multidisciplinary team must carefully inform the woman who chooses this path of the broad spectrum of implications, from cancer risk reduction to hormonal therapies.

Keywords: BRCA; breast cancer; endometrial cancer; gene mutation carrier; ovarian cancer; pathogenetic gene mutations; risk-reducing surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) Venn diagram showing mutated predisposing genes shared among hereditary ovarian, breast, and endometrial cancer [7]. (B) Estimated global age-standardized tumor incidences and mortality rates (female population only) according to GLOBOCAN data in 2020 (www.iarc.fr—World Health Organisation (WHO), access on 22 November 2022).
Figure 2
Figure 2
Rankings of estimated age-standardized incidence rates (World) in female population in 2020. (A) Breast cancer. (B) Ovarian cancer. (C) Corpus uteri cancer.
Figure 3
Figure 3
Timing of risk-reducing procedures [20].
See this image and copyright information in PMC

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