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Young Breast Cancer patients: do they need a different surgery after NAC?

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- Valentina Sini -

Young Breast Cancer patients: do they need a different surgery after NAC?

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De-escalation

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CPM: contralateral prophylactic mastectomy

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40‒85% risk of breast cancer 40‒70% risk of breast cancer

26‒65% risk of ovarian cancer

15‒25% risk of ovarian cancer

5‒10% risk of male breast cancer 1% risk

of male breast cancer

2‒9% risk of male pancreatic cancer (no prostate risk)

4‒6% risk of male pancreatic/

prostate cancer

BRCA1 mutation risks BRCA2 mutation risks

50‒85% risk of breast cancer

26‒65% risk of ovarian cancer

Pruthi S, et al. Mayo Clinic Proceedings 2010;85:1111‒1120.

Ferla R, et al. Annals of Oncology 2007;18 (Suppl 6):vi93‒vi98.

Kirchhoff T, et al. Clin Cancer Res 2004;10:2918‒2921.

Greer JB, Whitcomb DC. Gut 2007;56:601–605.

Tai YC, et al. J Natl Cancer Inst 2007;99:1811–1814.

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Graeser et al. J Clin Oncol 2009

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Xiao Li et al, Clin Cancer Res 2016; Rebbeck et al. J Natl Canc Inst 2009; Finch et al. J Cl Oncol 2014

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• The young age in itself is not an indication to a different surgery

• Local therapy decisions are associated with a persistent impact on QoL in young breast cancer survivors

• Avoid overtreatment

• Take advantage of the time of neoadjuvant CT to address young patients to genetic counseling if indicated

• Recommend bilateral mastectomy (with CPM) to BRCA 1-2 carriers

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