The uptake rate of risk-reducing salpingo-oophorectomy among Thai women with breast cancer and germline BRCA pathogenic or likely pathogenic variants

Abstract

Germline BRCA1 and BRCA2 pathogenic and likely pathogenic variants (PVs) significantly increase the risk of breast cancer and ovarian cancer, forming the basis for hereditary breast and ovarian cancer syndrome. Current guidelines recommend risk-reducing salpingo-oophorectomy (RRSO) for women with PVs. This study aimed to evaluate the rate of uptake of RRSO among women with breast cancer who carry germline BRCA PVs. This retrospective study collected data from women with breast cancer who were identified to have germline BRCA PVs between 2020 and 2024 at Siriraj Hospital, Bangkok, Thailand. Baseline characteristics, including age, BMI, underlying diseases, menopausal status, recurrent or metastatic breast cancer, BRCA1 and BRCA2 PVs were recorded. The uptake rate and associated factors of RRSO among these women were analyzed. In addition, the time to surgery and pathological outcomes were evaluated in the RRSO group. One hundred and thirty-eight women were included in the final analysis. Among them, 81 (58.7%) underwent RRSO. Ovarian cancer was detected in six (7.4%) women who underwent RRSO. Factors associated with undergoing RRSO including age greater than or equal to 45 years and the absence of distant metastasis. The median interval between genetic testing and RRSO was 8 months. In the surveillance group, the median follow-up time was 39 months, and no cases of cancer were detected. The RRSO uptake rate among breast cancer patients with germline BRCA PVs was 58.7%. Efforts to improve this rate should focus on understanding reasons for refusal and offering alternative prevention strategies.