Co-operation of contralateral prophylactic mastectomy and risk-reducing salpingo-oophorectomy in Korean breast cancer patients with germline <i>BRCA1/2</i> mutation.

Abstract

e22651 Background: Carriers of germline BRCA1/2 pathogenic variants are considered at high risk for hereditary breast and ovarian cancer. In unilateral breast cancer patients with these variants, contralateral prophylactic mastectomy (CPM) and risk‐reducing salpingo-oophorectomy (RRSO) are recommended; however, undergoing two separate surgeries may pose a substantial burden on carriers. Methods: We retrospectively analyzed BRCA1/2 germline variant carriers who were diagnosed and treated for breast cancer at our institution between 2014 and 2024. Surgical duration, length of hospital stays, and recurrence-free survival (RFS) were compared between patients who underwent cooperative surgery (COS) and those who underwent standalone surgeries (SAS) for CPM and RRSO. Results: Among 554 carriers, 261 did not undergo preventive surgery, 54 underwent CPM only, 132 underwent RRSO only, and 107 underwent both CPM and RRSO. Of the 101 patients who underwent both surgeries at our institution, 83 underwent COS and 18 underwent SAS. The cohort included 44 BRCA1 and 57 BRCA2 carriers, with no significant differences between groups in mutation type, family history, or breast cancer subtype. The age at breast cancer diagnosis and the age at CPM were younger in the SAS group (39.3 years) than in the COS group (48.4 years) (p&lt;0.001), and the age at RRSO was also younger in the SAS group (41.1 years) compared with COS (48.7 years). There were no differences between groups in CPM surgical method, concurrent breast reconstruction, or hysterectomy at the time of RRSO. Total operative time was significantly shorter in the COS group (352.5 minutes) compared with SAS (409.0 minutes) (p=0.035). Length of hospital stay was also shorter in the COS group (6 days) than in the SAS group (16 days). Postoperative breast surgery complications did not differ between groups. Mean RFS was 133.1 months in the COS group and 128.1 months in the SAS group (p=0.039), and median RFS was not reached in either group. In multivariable Cox regression, the only statistically significant factor was age at breast cancer diagnosis (&lt;40 years). Conclusions: Among Korean carriers of BRCA1/2 germline pathogenic variants with breast cancer, COS was associated with shorter operative time and reduced hospitalization compared with SAS, without inferiority in postoperative complications or recurrence-free survival. Further research is warranted to evaluate long-term oncologic outcomes and patient-reported satisfaction.