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Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review

This narrative review aims to clarify the role of breast and gynecological risk-reduction surgery in BRCA mutation carriers. We examine the indications, contraindications, complications, technical aspects, timing, economic impact, ethical issues, and prognostic benefits of the most common prophylact...

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Autores principales: Bertozzi, Serena, Londero, Ambrogio P., Xholli, Anjeza, Azioni, Guglielmo, Di Vora, Roberta, Paudice, Michele, Bucimazza, Ines, Cedolini, Carla, Cagnacci, Angelo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9967164/
https://www.ncbi.nlm.nih.gov/pubmed/36835955
http://dx.doi.org/10.3390/jcm12041422
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author Bertozzi, Serena
Londero, Ambrogio P.
Xholli, Anjeza
Azioni, Guglielmo
Di Vora, Roberta
Paudice, Michele
Bucimazza, Ines
Cedolini, Carla
Cagnacci, Angelo
author_facet Bertozzi, Serena
Londero, Ambrogio P.
Xholli, Anjeza
Azioni, Guglielmo
Di Vora, Roberta
Paudice, Michele
Bucimazza, Ines
Cedolini, Carla
Cagnacci, Angelo
author_sort Bertozzi, Serena
collection PubMed
description This narrative review aims to clarify the role of breast and gynecological risk-reduction surgery in BRCA mutation carriers. We examine the indications, contraindications, complications, technical aspects, timing, economic impact, ethical issues, and prognostic benefits of the most common prophylactic surgical options from the perspectives of a breast surgeon and a gynecologist. A comprehensive literature review was conducted using the PubMed/Medline, Scopus, and EMBASE databases. The databases were explored from their inceptions to August 2022. Three independent reviewers screened the items and selected those most relevant to this review’s scope. BRCA1/2 mutation carriers are significantly more likely to develop breast, ovarian, and serous endometrial cancer. Because of the Angelina effect, there has been a significant increase in bilateral risk-reducing mastectomy (BRRM) since 2013. BRRM and risk-reducing salpingo-oophorectomy (RRSO) significantly reduce the risk of developing breast and ovarian cancer. RRSO has significant side effects, including an impact on fertility and early menopause (i.e., vasomotor symptoms, cardiovascular disease, osteoporosis, cognitive impairment, and sexual dysfunction). Hormonal therapy can help with these symptoms. Because of the lower risk of developing breast cancer in the residual mammary gland tissue after BRRM, estrogen-only treatments have an advantage over an estrogen/progesterone combined treatment. Risk-reducing hysterectomy allows for estrogen-only treatments and lowers the risk of endometrial cancer. Although prophylactic surgery reduces the cancer risk, it has disadvantages associated with early menopause. A multidisciplinary team must carefully inform the woman who chooses this path of the broad spectrum of implications, from cancer risk reduction to hormonal therapies.
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spelling pubmed-99671642023-02-26 Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review Bertozzi, Serena Londero, Ambrogio P. Xholli, Anjeza Azioni, Guglielmo Di Vora, Roberta Paudice, Michele Bucimazza, Ines Cedolini, Carla Cagnacci, Angelo J Clin Med Review This narrative review aims to clarify the role of breast and gynecological risk-reduction surgery in BRCA mutation carriers. We examine the indications, contraindications, complications, technical aspects, timing, economic impact, ethical issues, and prognostic benefits of the most common prophylactic surgical options from the perspectives of a breast surgeon and a gynecologist. A comprehensive literature review was conducted using the PubMed/Medline, Scopus, and EMBASE databases. The databases were explored from their inceptions to August 2022. Three independent reviewers screened the items and selected those most relevant to this review’s scope. BRCA1/2 mutation carriers are significantly more likely to develop breast, ovarian, and serous endometrial cancer. Because of the Angelina effect, there has been a significant increase in bilateral risk-reducing mastectomy (BRRM) since 2013. BRRM and risk-reducing salpingo-oophorectomy (RRSO) significantly reduce the risk of developing breast and ovarian cancer. RRSO has significant side effects, including an impact on fertility and early menopause (i.e., vasomotor symptoms, cardiovascular disease, osteoporosis, cognitive impairment, and sexual dysfunction). Hormonal therapy can help with these symptoms. Because of the lower risk of developing breast cancer in the residual mammary gland tissue after BRRM, estrogen-only treatments have an advantage over an estrogen/progesterone combined treatment. Risk-reducing hysterectomy allows for estrogen-only treatments and lowers the risk of endometrial cancer. Although prophylactic surgery reduces the cancer risk, it has disadvantages associated with early menopause. A multidisciplinary team must carefully inform the woman who chooses this path of the broad spectrum of implications, from cancer risk reduction to hormonal therapies. MDPI 2023-02-10 /pmc/articles/PMC9967164/ /pubmed/36835955 http://dx.doi.org/10.3390/jcm12041422 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Bertozzi, Serena
Londero, Ambrogio P.
Xholli, Anjeza
Azioni, Guglielmo
Di Vora, Roberta
Paudice, Michele
Bucimazza, Ines
Cedolini, Carla
Cagnacci, Angelo
Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review
title Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review
title_full Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review
title_fullStr Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review
title_full_unstemmed Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review
title_short Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review
title_sort risk-reducing breast and gynecological surgery for brca mutation carriers: a narrative review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9967164/
https://www.ncbi.nlm.nih.gov/pubmed/36835955
http://dx.doi.org/10.3390/jcm12041422
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