Sergio Cifuentes Canaval, Medical Oncologist at Las Américas Auna Clinic, shared a post on X:
”Clinical case recap (brief) 26-yo, BRCA1+, grade 3 IDC, TNBC, achieved pCR (ypT0N0) after NACT. Wishes pregnancy and breastfeeding soon, and plans a risk-reducing mastectomy after lactation. MDT: define adj RT and timing of RRM.
Key evidence to consider — BRCA biology and awareness Young BRCA carriers often show distinct clinical behavior; early awareness of germline status influences treatment and reproductive planning (Matteo Lambertini et al., JCO).
Knowing BRCA at diagnosis changes risk discussion, timing of surgeries and fertility counseling.
– A total of 78.6%) and 63.4% patients in the BRCA test-before– and BRCA test-at-diagnosis groups underwent risk-reducing mastectomy.
Title: Clinical Behavior of Breast Cancer in Young BRCA Carriers and Prediagnostic Awareness of Germline BRCA Status
Authors: Matteo Lambertini, Eva Blondeaux, Loredana M. Tomasello, Elisa Agostinetto, Anne-Sophie Hamy, Hee Jeong Kim, Maria Alice Franzoi, Rinat Bernstein-Molho, Florentine Hilbers, Katarzyna Pogoda, Hans Wildiers, Jyoti Bajpai, Michail Ignatiadis, Halle C.F. Moore, Ann H. Partridge, Kelly-Anne Phillips, Angela Toss, Christine Rousset-Jablonski, Carmen Criscitiello, Tiphaine Renaud, Alberta Ferrari, Shani Paluch-Shimon, Robert Fruscio, Wanda Cui, Stephanie M. Wong, Claudio Vernieri, Kathryn J. Ruddy, Maria Vittoria Dieci, Alexios Matikas, Mariya Rozenblit, Cynthia Villarreal-Garza, Laura De Marchis, Fabio Puglisi, Kenny A. Rodriguez-Wallberg, Francois P. Duhoux, Luca Livraghi, Marco Bruzzone, Luca Boni, Judith Balmaña
Read the Full Article.
Risk-reducing surgery and survival. A large international cohort suggests association between risk-reducing surgeries and improved outcomes in young BRCA carriers with breast cancer.
Important when counselling on the survival benefit and timing of prophylactic mastectomy vs. delayed approach after childbearing. (Blondeaux et al., Lancet Oncol).
Title: Association between risk-reducing surgeries and survival in young BRCA carriers with breast cancer: an international cohort study
Authors: Eva Blondeaux, Amir Sonnenblick, Elisa Agostinetto, Raphaëlle Bas, Prof Hee J Kim, Maria A Franzoi, Rinat Bernstein-Molho, Sabine Linn, Prof Ava Kwong, Katarzyna Pogoda, Judith Balmana, Ann Smeets, Jyoti Bajpai, Prof Halle C F Moore, Ann H Partridge, Prof Kelly-Anne Phillips, Angela Toss, Christine Rousset-Jablonski, Fedro A Peccatori, Tiphaine Renaud, Alberta Ferrari, Shani Paluch-Shimon, Pablo Mando, Jeong E Lee, Robert Fruscio, Wanda Cui, Stephanie M Wong, Claudio Vernieri, Kathryn J Ruddy, Maria V Dieci, Alexios Matikas, Mariya Rozenblit, Deniz C Guven, Minna Lee, Cynthia Villarreal-Garza, Shelley E Hwang, Laura De Marchis, Fabio Puglisi, Zoe Kemp, Pedro A Meireles, Anastasia Parokonnaya, Gustavo Werutsky, Maiko Okano, Hatem A Azim, Kleida Mati, Shoshana Rosenberg, Richard Gelber, Luca Boni, Matteo Lambertini
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Pregnancy / lactation considerations Data from prospective studies addressing pregnancy and lactation after breast cancer (including trials like POSITIVE for endocrine interruptions) support individualized planning and multidisciplinary monitoring.
Although POSITIVE focused on HR+ patients, its framework for fertility/pregnancy counseling and safety monitoring is informative.
Title: Breastfeeding After Hormone Receptor–Positive Breast Cancer: Results From the POSITIVE Trial
Authors: Fedro A. Peccatori, Samuel M. Niman, Ann H. Partridge, Monica Ruggeri, Marco Colleoni, Cristina Saura, Chikako Shimizu, Anna B. Satersdal, Judith R. Kroep, Karen Gelmon, Frederic Amant, Audrey Mailliez, Halle C.F. Moore, Manuel Ruiz-Borrego, Janice M. Walshe, Virginia F. Borges, Andrea Gombos, Akemi Kataoka, Christine Rousset-Jablonski, Simona Borstnar, Junko Takei, Jeong E. Lee, Christobel Saunders, Vesna Bjelic-Radisic, Snezana Susnjar, Fatima Cardoso, Natalie J. Klar, Teresa Ferreiro, Sarra El-Abed, Martine Piccart, Larissa A. Korde, Aron Goldhirsch, Richard D. Gelber, Olivia Pagani, Hatem A. Azim Jr
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How these data inform our case – practical points
- Timing of RRM: Survival data support benefit from risk-reducing surgery, but many BRCA carriers delay RRM until after childbearing. A planned RRM after completion of pregnancy & lactation is a reasonable.
- Breastfeeding: For triple-negative disease with pCR, breastfeeding is often possible and can be supported — but counseling should include risk/benefit, lactation risks after surgery, and implications for timing of prophylactic procedures.
- Adjuvant radiotherapy: pCR (ypT0N0) reduces locoregional risk, but BRCA1 status, prior tumor size, and surgical choice (conserving vs mastectomy) must enter the decision. MDT discussion is key to individualize need for RT.
Additional considerations for LATAM practice and patient values:
- Fertility referral (oocyte cryopreservation) and psychosocial support .
- Shared decision-making should present survival data, surgical risks, breastfeeding goals, and psychosocial priorities.
Invite to discussion Matteo Lambertini, Luca Arecco, Elisa Agostinetto, Oncology Brothers.
How would you counsel timing of RRM in this scenario? Would you recommend interim intensified surveillance instead of immediate RRM?
Thoughts on RT in BRCA1 carriers with pCR?”
More from Sergio Cifuentes Canaval on OncoDaily.
