Risk-reducing surgery for BRCA1/2 genetic mutation carriers

Abstract

Patients with a BRCA1 or BRCA2 (BRCA) are at high risk for developing breast cancer which may be mitigated through risk-reducing surgery. Risk-reducing mastectomy has been shown to reduce the risk of breast cancer by 90% or more among high-risk women including BRCA mutation carriers. The decision to undergo prophylactic surgery is a choice that patients make, in conjunction with their multidisciplinary healthcare team which often includes genetic counselors, surgeons, and additional professionals they can access to provide psychosocial support to assist women determine if they want surgery and, if so, the timing. Surgical options for mastectomy include a simple mastectomy without reconstruction or either a skin-sparing mastectomy or a nipple-sparing mastectomy with reconstruction. Clinical surveillance must continue at least annually for women after risk-reducing mastectomy because there remains a small, albeit greatly reduced, lifetime risk of breast cancer (<5%) after mastectomy.