Elizabeth Lokich, from Warren Alpert Medical School of Brown University in Providence, RI, and colleagues conducted a retrospective cohort study involving 302 women with breast cancer who underwent BRCA mutation testing prior to surgery. Surgical choice and change in surgical choice were compared for women that tested positive and negative for a BRCA mutation.
The researchers found that 10.6% of the participants were BRCA carriers. Most participants had early-stage disease; 55.6% had T1 lesions and 72.8% were node negative. More than half of the women (55.6%) underwent breast-conserving surgery, while the remainder underwent unilateral or bilateral mastectomy. The likelihood of having both a personal history of breast cancer (odds ratio, 2.74) and hormone receptor-negative tumors (P=0.002) was increased among BRCA mutation carriers. The choice to undergo bilateral mastectomy with reconstruction was more likely among BRCA carriers (56.3 vs. 15.9%; P<0.0001). Compared with mutation-negative patients, BRCA carriers were more likely to opt for a different surgery than was initially planned by their surgeon (71.9 vs. 29%, respectively; P<0.0001).
“BRCA mutation testing strongly influences surgical decision making in newly diagnosed breast cancer patients,” the authors write.