In an Italian single-institution retrospective study reported in JAMA Surgery, Martelli et al found that prophylactic salpingo-oophorectomy was associated with improved overall survival in patients who had undergone resection of germline BRCA1/2-mutant breast cancer.
Study Details
The study included 480 consecutive patients with breast cancer and BRCA1 or BRCA2 germline variants who were followed from the time of genetic testing after quadrantectomy or mastectomy between 1972 and 2019 at the Italian National Cancer Institute, Milan. Overall, 300 patients (62.5%) underwent prophylactic salpingo-oophorectomy at a median of 51.2 months (interquartile range [IQR] = 17.8–134.6 months) after surgery.
Key Findings
Median follow-up was 198 months (IQR = 125–307 months). Receipt of prophylactic salpingo-oophorectomy was associated with a significantly reduced risk of death vs no prophylactic salpingo-oophorectomy (hazard ratio [HR] = 0.40, 95% CI confidence interval [CI] = 0.25–0.64, P < .001); reductions in risk were most evident among patients with BRCA1 variants (HR = 0.35, 95% CI = 0.20–0.63, P = .001), those with triple-negative disease (HR = 0.21, 95% CI = 0.09–0.46, P = .002), and those with invasive ductal carcinoma (HR = 0.51, 95% CI = 0.31–0.84, P = .008). At the time of analysis, the overall survival probability was 82.7% in the prophylactic salpingo-oophorectomy group; median overall survival was 273.4 months, with a survival probability of 55.3%, in the no prophylactic salpingo-oophorectomy group.
The study findings suggest that prophylactic salpingo-oopherectomy should be offered to all patients with [germline BRCA1/2-mutant breast cancer] who undergo surgery with curative intent to reduce risk of death. In particular, prophylactic salpingo-oopherectomy should be offered to patients with the BRCA1 variant at the time of breast surgery.— Martelli et al
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For prophylactic salpingo-oophorectomy vs no prophylactic salpingo-oophorectomy, hazard ratios for breast cancer–specific mortality were 0.93 (95% CI = 0.41–2.13) for BRCA1 variants and 1.04 (95% CI = 0.43–2.47) for BRCA2 variants. Prophylactic salpingo-oophorectomy vs no prophylactic salpingo-oophorectomy was not associated with a reduced risk of contralateral breast cancer (HRs = 1.12, 95% CI 0.69–1.82 for BRCA1 variants and 0.86, 95% CI = 0.44–1.70 for BRCA2 variants) or ipsilateral breast tumor recurrence.
Among 180 patients who did not undergo prophylactic salpingo-oophorectomy, 77 (42.8%; n = 58 with BRCA1 variants and n = 19 with BRCA2 variants) developed ovarian cancer, with 40 (22.2%) dying of the disease. A total of 35 patients (19.4%) died of breast cancer.
A total of 163 patients (34.0%) underwent prophylactic mastectomy at a median of 11.2 months (IQR = 0.0–45.3 months) after surgery. Prophylactic mastectomy was associated with a reduced risk of ipsilateral breast tumor recurrence but not with improved overall survival or breast cancer–specific mortality.
The investigators concluded: “The study findings suggest that prophylactic salpingo-oophorectomy should be offered to all patients with [germline BRCA1/2-mutant breast cancer] who undergo surgery with curative intent to reduce the risk of death. In particular, prophylactic salpingo-oophorectomy should be offered to patients with the BRCA1 variant at the time of breast surgery.”
Gabriele Martelli, MD, of the Breast Unit, Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, is the corresponding author of the JAMA Surgery article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
