Researchers studied whether nipple-sparing mastectomy was a safe surgical procedure for breast cancer prevention in women with BRCA gene mutations who are at high risk of developing breast cancer.
There are many different risks for breast cancer, but one important factor is a family history of the disease. Researchers have discovered that in some families with several cases of breast cancer, there is a mutation of the breast cancer suppressor genes (BRCA). These genes normally control cell division in the breast, so abnormal BRCA genes increase the risk of developing breast cancer. Women with BRCA mutations have about a 50% chance of developing breast cancer over the course of their lifetime, compared with around 12% for women in the general population in the USA. Because of this increased risk, some women with BRCA mutations may be considered for surgery to remove their breasts (mastectomy) for breast cancer prevention.
There are different types of mastectomy which remove different amounts of breast tissue. A nipple-sparing mastectomy leaves behind the nipple and the surrounding skin. This procedure is becoming more widely used as it gives a very good cosmetic result, but it may not be the best choice for every patient. Researchers at the Mayo Clinic (USA) studied whether this procedure is a safe choice for women with BRCA mutations being offered preventative mastectomy. They recently published their findings in JAMA Surgery.
The researchers reviewed the experience at nine different institutions which had performed nipple-sparing mastectomies between 1968 and 2013 in women with BRCA mutations. A total of 548 procedures were performed in 346 patients (some patients had nipple-sparing mastectomies on both breasts, and some had nipple-sparing mastectomies on one breast after surgery for cancer in the other breast). Patients were followed up for an average of 34 months. Breast cancer did not develop in any of the patients during that time.
Although the length of follow-up was relatively short, the researchers concluded that nipple-sparing mastectomies are safe and highly preventative against breast cancer in women with BRCA mutations. They suggest that nipple-sparing mastectomies should be offered to appropriate patients with BRCA mutations to reduce their risk of developing breast cancer.
Written by Julie McShane, Medical Writer
Jakub J, Warren Peled A, Gray RJ, et al. Oncologic safety of prophylactic nipple-sparing mastectomy in a population with BRCA mutations. A multi-institutional study. JAMA Surgery Published online September 13, 2017. Doi: 10.1001/jamasurg.2017.3422