Аннотация:Background Little evidence exists on the effect of risk-reducing surgeries in young BRCA carriers with a previous history
of breast cancer. We investigated the association between risk-reducing mastectomy (RRM) or risk-reducing salpingooophorectomy (RRSO), or both procedures, with survival outcomes in a large global cohort of young BRCA carriers with
previous breast cancer.
Methods The BRCA BCY Collaboration is an international, hospital-based, retrospective cohort study, conducted at
109 centres in five continents, including women harbouring germline BRCA1, BRCA2, or both, pathogenic or likely
pathogenic variants and diagnosed with stage I–III invasive breast cancer at the age of 40 years or younger between
Jan 1, 2000, and Dec 31, 2020. The primary objectives of the present analysis were to determine the association between
RRM or RRSO and overall survival in young BRCA carriers with breast cancer. The primary endpoint was overall survival.
This study is registered with ClinicalTrials.gov, NCT03673306.
Findings Between Jan 1, 2000 and Dec 31, 2020, 5290 patients were included, of whom 3361 (63·5%) patients were
BRCA1 pathogenic variant carriers, 2708 (51·2%) had node-negative, and 2421 (45·8%) hormone receptor-positive breast
cancer. Of 5290 patients, 2910 (55·0%) underwent RRM, 2782 (52·6%) underwent RRSO. After a median follow-up of
8·2 years (IQR 4·7–12·8), RRM was associated with significantly better overall survival compared with no RRM (adjusted
HR [aHR] 0·65, 95% CI 0·53–0·78; 20-year restricted mean overall survival time 17·89 years [95% CI 17·61–18·17] with
RRM vs 16·65 years [16·38–16·92] without RRM). RRSO was also associated with significantly better overall survival
compared with no RRSO (aHR 0·58, 95% CI 0·48–0·71; 20-year restricted mean overall survival time 17·73 years
[95% CI 17·43–18·03] with RRSO vs 16·67 years [16·38–16·96] without RRSO).
Interpretation In this global cohort of BRCA carriers with previous breast cancer diagnosis at a young age, RRM and
RRSO were both associated with a significant improvement in overall survival. These findings provide evidence for a
tailored counselling of a unique and high-risk patient population on cancer risk management s