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Peer-reviewedCC BYHereditary cancer in clinical practice

Trends in the uptake of nipple sparing mastectomy in BRCA1/2, PALB2 and other pathogenic variant carriers undergoing risk reducing mastectomy.

  • Marya Alsuhaibani1,2
  • Amel Melanson1,2
  • Alex Viezel-Mathieu3
  • Tassos Dionisopoulos3
  • Mark Basik1,4,5
  • Jean Francois Boileau1
  • Karyne Martel1
  • Sarkis Meterissian1,4
  • Joshua Vorstenbosch3
  • Victor Villareal-Corpuz2
  • William D Foulkes2,4,5,6
  • Ipshita Prakash1,4,5
1 more authors
  • Stephanie M Wong7,8,9,10,11
11 affiliations
  1. 1Department of Surgery, McGill University, Montreal, QC, Canada.
  2. 2Stroll Cancer Prevention Centre, Jewish General Hospital, Montreal, QC, Canada.
  3. 3Department of Plastic and Reconstructive Surgery, McGill University, Montreal, QC, Canada.
  4. 4Department of Oncology, McGill University, Montreal, QC, Canada.
  5. 5Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.
  6. 6Department of Human Genetics, McGill University, Montreal, QC, Canada.
  7. 7Department of Surgery, McGill University, Montreal, QC, Canada. [email protected].
  8. 8Stroll Cancer Prevention Centre, Jewish General Hospital, Montreal, QC, Canada. [email protected].
  9. 9Department of Oncology, McGill University, Montreal, QC, Canada. [email protected].
  10. 10Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada. [email protected].
  11. 11Segal Cancer Centre, Jewish General Hospital, 3755 Cote Ste Catherine, E713, Montreal, QC, H3T1E2, Canada. [email protected].
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Abstract

Introduction

Risk-reducing mastectomy (RRM) for germline pathogenic variant (GPVs) carriers were historically performed as total mastectomy (TM) or skin-sparing mastectomy (SSM), although nipple-sparing mastectomy (NSM) has recently emerged as an oncologically safe RRM option.Methods

This retrospective cohort study included all female patients with confirmed BRCA1, BRCA2, PALB2, or other high-penetrance GPVs at two academic institutions in Canada between 2003 and 2024. Temporal trends in NSM uptake were assessed using the Mantel-Haenszel test for trend and multivariable logistic regression.Results

After exclusions, 559 GPV carriers including 319 (57%) affected carriers and 240 (43%) unaffected carriers comprised the study cohort. The median age at RRM was 45 years old (range 22-76) and most were BRCA1 carriers (46.7%) or BRCA2 carriers (44.4%). Overall, 310 carriers (55.5%) underwent NSM, 174 (31.1%) underwent SSM, and 75 (13.4%) underwent TM. NSM uptake was highest among patients aged 40-49 years (56%) and lowest in those ≥ 60 years (42%, p = 0.03). Relative to unaffected carriers, affected carriers (47% vs. 66%, p < 0.001) and those with prior radiation were less likely to undergo NSM (34.3% vs. 62.7%, p < 0.001). A clear increase in NSM occurred over time, from 11.9% pre-2012 to 74.4% after 2022 (p < 0.001). Multivariable analysis adjusting for age, GPV, parity, menopausal status, and personal history of breast cancer identified normal BMI (OR 1.99, 95% CI 1.18-3.34), lack of radiation exposure (OR 3.03, 95% CI 1.76-5.23), and year of surgery as independent predictors of NSM receipt (OR 1.25, 95% CI 1.19-1.32).Conclusion

There has been a significant increase in NSM use among BRCA1/2, PALB2 and other GPV carriers over the last two decades.

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Cite

BibTeXRIS
BibTeX
@article{alsuhaibani2026trends,
  title = {{Trends in the uptake of nipple sparing mastectomy in BRCA1/2, PALB2 and other pathogenic variant carriers undergoing risk reducing mastectomy.}},
  author = {Marya Alsuhaibani and Amel Melanson and Alex Viezel-Mathieu and Tassos Dionisopoulos and Mark Basik and Jean Francois Boileau and Karyne Martel and Sarkis Meterissian and Joshua Vorstenbosch and Victor Villareal-Corpuz and William D Foulkes and Ipshita Prakash and Stephanie M Wong},
  journal = {Hereditary cancer in clinical practice},
  year = {2026},
  month = jul,
  doi = {10.1186/s13053-026-00351-0},
  url = {https://europepmc.org/article/MED/42902324},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Trends in the uptake of nipple sparing mastectomy in BRCA1/2, PALB2 and other pathogenic variant carriers undergoing risk reducing mastectomy.
AU  - Marya Alsuhaibani
AU  - Amel Melanson
AU  - Alex Viezel-Mathieu
AU  - Tassos Dionisopoulos
AU  - Mark Basik
AU  - Jean Francois Boileau
AU  - Karyne Martel
AU  - Sarkis Meterissian
AU  - Joshua Vorstenbosch
AU  - Victor Villareal-Corpuz
AU  - William D Foulkes
AU  - Ipshita Prakash
AU  - Stephanie M Wong
PY  - 2026
DA  - 2026/07/01
JO  - Hereditary cancer in clinical practice
DO  - 10.1186/s13053-026-00351-0
UR  - https://europepmc.org/article/MED/42902324
AB  - Introduction  Risk-reducing mastectomy (RRM) for germline pathogenic variant (GPVs) carriers were historically performed as total mastectomy (TM) or skin-sparing mastectomy (SSM), although nipple-sparing mastectomy (NSM) has recently emerged as an oncologically safe RRM option.Methods  This retrospective cohort study included all female patients with confirmed BRCA1, BRCA2, PALB2, or other high-penetrance GPVs at two academic institutions in Canada between 2003 and 2024. Temporal trends in NSM uptake were assessed using the Mantel-Haenszel test for trend and multivariable logistic regression.Results  After exclusions, 559 GPV carriers including 319 (57%) affected carriers and 240 (43%) unaffected carriers comprised the study cohort. The median age at RRM was 45 years old (range 22-76) and most were BRCA1 carriers (46.7%) or BRCA2 carriers (44.4%). Overall, 310 carriers (55.5%) underwent NSM, 174 (31.1%) underwent SSM, and 75 (13.4%) underwent TM. NSM uptake was highest among patients aged 40-49 years (56%) and lowest in those ≥ 60 years (42%, p = 0.03). Relative to unaffected carriers, affected carriers (47% vs. 66%, p < 0.001) and those with prior radiation were less likely to undergo NSM (34.3% vs. 62.7%, p < 0.001). A clear increase in NSM occurred over time, from 11.9% pre-2012 to 74.4% after 2022 (p < 0.001). Multivariable analysis adjusting for age, GPV, parity, menopausal status, and personal history of breast cancer identified normal BMI (OR 1.99, 95% CI 1.18-3.34), lack of radiation exposure (OR 3.03, 95% CI 1.76-5.23), and year of surgery as independent predictors of NSM receipt (OR 1.25, 95% CI 1.19-1.32).Conclusion  There has been a significant increase in NSM use among BRCA1/2, PALB2 and other GPV carriers over the last two decades.
SN  - 1731-2302
SN  - 1897-4287
ER  -