The increasing role of breast-conserving treatment in patients with BRCA-related breast cancer: an appraisal of recent literature.

Breast-conserving therapy (BCT) in BRCA-associated breast cancer remains a subject of ongoing debate, primarily due to concerns regarding local recurrence and the development of second primary tumors. This review provides a critical appraisal of the current evidence comparing BCT and mastectomy, integrating oncologic outcomes with biological insights and patient-centered perspectives. Evidence from cohort studies and meta-analyses indicates that, although BCT is associated with a higher incidence of ipsilateral breast events, this does not translate into inferior long-term survival. This apparent divergence may reflect the distinct biological profile of BRCA-associated tumors, characterized by impaired DNA repair mechanisms and increased responsiveness to systemic treatments, which may enhance therapeutic efficacy, particularly in the neoadjuvant setting. Recent advances in systemic therapies, including PARP inhibitors, along with improvements in radiotherapy and imaging, have broadened the clinical applicability of breast-conserving strategies. Furthermore, considerations related to quality of life and patient preferences reinforce the importance of individualized surgical planning. In this context, BCT can be considered a valid and oncologically sound option for selected BRCA mutation carriers, supporting a tailored multidisciplinary approach to treatment decision-making.