A 38-year-old BRCA1 mutation carrier who has completed childbearing requests prophylactic surgery. She has dense breasts on mammography and no evidence of cancer. The most appropriate surgical counselling includes which combination?
- A Risk-reducing bilateral mastectomy reduces breast cancer risk by approximately 90-95%; bilateral salpingo-oophorectomy (BSO) should also be discussed for ovarian cancer risk reduction ✓
- B BSO alone is sufficient to reduce both breast and ovarian cancer risk to baseline
- C Prophylactic mastectomy is not indicated until age 40; annual MRI surveillance is preferred
- D Chemoprevention with tamoxifen provides equivalent risk reduction to prophylactic mastectomy in BRCA1 carriers
Correct answer: A. Risk-reducing bilateral mastectomy reduces breast cancer risk by approximately 90-95%; bilateral salpingo-oophorectomy (BSO) should also be discussed for ovarian cancer risk reduction
Explanation
Risk-reducing bilateral mastectomy reduces breast cancer risk by 90-95% in BRCA1/2 carriers. BRCA1 carriers have up to 72% lifetime breast cancer risk and 44% ovarian cancer risk; thus BSO is additionally recommended, ideally between ages 35-40, which also reduces breast cancer risk by about 50% through estrogen reduction. Tamoxifen is less effective in BRCA1 carriers (which are often ER-negative). Annual MRI surveillance is an alternative if the patient declines surgery.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.