Risk Reduction and Survival Benefit of Prophylactic Surgery in BRCA Mutation Carriers, A Systematic Review

Abstract Background Hereditary breast and ovarian cancer (HBOC) syndrome due to mutations in BRCA1/2 genes results in an elevated risk for developing both breast and ovarian cancer over the lifetime of affected carriers. General surgeons may be faced with questions about surgical risk reduction and survival benefit of prophylactic surgery. Data Sources A systematic literature review was performed using the electronic databases PubMed, OVID MEDLINE, and Scopus comparing prophylactic surgery versus observation with respect to breast and ovarian cancer risk reduction and mortality in BRCA mutation carriers. Conclusions Bilateral risk-reducing mastectomy provides a 90-95% risk reduction in BRCA mutation carriers, although the data does not demonstrate improved mortality. The reduction in ovarian and breast cancer risks with the use of risk-reducing bilateral salpingo-oophorectomy has translated to improvement in survival. Clinical management of patients at increased risk for breast cancer requires consideration of risk and quality of life.