Italian maxi-studio

Breast cancer: preventive surgery saves the lives of those already ill

Breakthrough for women with Brca mutation: preventive removal of breasts and ovaries reduces recurrences and mortality by up to 42% even after a cancer diagnosis

by Francesca Cerati

7 May 2025

3' min read

Key points

What is the Brca mutation?
Angelina Jolie's precedent
New guidelines

3' min read

It is no longer just a drastic choice for those who want to prevent. The surgical removal of breasts, ovaries and fallopian tubes - until now reserved for healthy women who are carriers of the Brca genetic mutation - can save the lives of those who have already been diagnosed with breast cancer. This is confirmed, for the first time in the world, by international research led by the Irccs Ospedale Policlinico San Martino in Genoa, published today in The Lancet Oncology. The study, supported by Airc, analysed data from more than 5,000 patients under 40 from 33 countries, followed over a period of twenty years.

In particular, the study - led by oncologists Matteo Lambertini and Eva Blondeaux - analysed the data of 5,290 women under 40 with a diagnosis of breast cancer and Brca mutations, treated between 2000 and 2020. Of these, 2,910 opted for bilateral mastectomy, 2,782 for ovary and tube removal, and 1,804 underwent both operations. About 1,400 did not undergo either procedure.

The numbers speak for themselves: bilateral mastectomy reduces mortality by 35% and the risk of recurrence by 42%; removal of the ovaries and tubes, on the other hand, leads to a 42% drop in mortality and a 32% reduction in recurrences. A double surgical option, hitherto underestimated for those who had already faced the disease, now proves to be decisive even after diagnosis. An important benefit that has been observed regardless of age at diagnosis, tumour size and aggressiveness, and previous chemotherapy, if any.

"This is the first time that the significant advantage of preventive surgery in this group of patients has been demonstrated with solid data," explains Matteo Lambertini, Associate Professor of Medical Oncology at the University of Genoa and study coordinator. "Until now, in women already affected by breast cancer, bilateral mastectomy was a discussed but not strongly recommended option, due to a lack of evidence on the impact on survival. Now we have evidence that these surgical options not only improve prognosis, but can save lives'.

What is the Brca mutation?

The Brca1 and Brca2 (short for Breast Cancer) genes are normally responsible for DNA repair. When they mutate, they lose their ability to fight tumour growth, drastically increasing the risk of certain cancers. Women with hereditary Brca1 or Brca2 mutations have up to a 70% chance of developing breast cancer and between 20 and 45% chance of contracting ovarian cancer in their lifetime.

The mutation is genetic, and is transmitted with a 50% probability from parents to offspring. In contrast to most cancers, which are related to environmental or age-related factors, Brca-related forms often affect very young women, even under 40 years of fertile age.

The research also emphasises the importance of genetic counselling to support complex choices, often marked by profound implications such as infertility and early menopause. "For many young women, who receive the diagnosis at childbearing age, the emotional and physical burden of these interventions is enormous. But this scientific evidence can help them make more informed decisions," emphasises Eva Blondeaux, oncologist and first author of the study

Angelina Jolie's precedent

Global interest in Brca mutations exploded in 2013, when Angelina Jolie publicly announced her choice to undergo a preventive double mastectomy after discovering she carried the Brca1 mutation. Two years later, in 2015, the actress also opted to have her ovaries and tubes removed, following the deaths of her mother, grandmother and aunt due to Brca-related cancers.

Jolie's then pioneering and controversial choice prompted thousands of women around the world to undergo genetic testing and consider preventive surgery. Today, with new data in hand, that decision proves valid not only in those who wish to prevent, but also in those who have already encountered the disease.

Towards new guidelines

The change in perspective is relevant. 'This study provides evidence that needs to be incorporated into future clinical guidelines,' Lambertini reiterates, 'and highlights how both surgeries are key risk management strategies for this group of women.

The message is clear: preventive surgery should no longer be considered just a risk strategy in healthy carriers, but a key component of treatment even in young women already affected by the disease. And for patients, accompanied by dedicated genetic counselling, it means being able to consciously choose an option that not only prevents, but saves.