Several studies have investigated the differences in tumour characteristics between breast cancer in BRCA1-carriers and other patients, aiming to obtain insight into features that might be of importance for recognizing patients with BRCA1-related tumours. In many studies, it was observed that BRCA1-associated breast cancers are more frequently histologic grade 3 (Eisinger et al, 1996;Marcus et al, 1996;Johannsson et al, 1997;Karp et al, 1997;Lakhani et al, 1997;Armes et al, 1998;Lynch et al, 1998) and that they express receptors for oestrogen and progesterone less frequently (Johannsson et al, 1997;Karp et al, 1997;Lynch et al, 1998;Loman et al, 1998Verhoog et al, 1998Armes et al, 1999). Both features are usually associated with a poorer prognosis.However, all studies were performed on highly selected groups of patients, which might lead to survival bias and underestimation of the differences under study. The majority of studies examined tumours from families with a high incidence of breast cancer (Eisinger et al, 1996;Marcus et al, 1996;Johannsson et al, 1997;Lakhani et al, 1997;Loman et al, 1998;Lynch et al, 1998;Verhoog et al, 1998), from patients with an early onset breast cancer (Armes et al, 1998(Armes et al, , 1999, or from specific populations with founder mutations (Karp et al, 1997). Moreover, in most studies in which the cases were selected from breast cancer families, the controls were breast cancer patients without a positive family history but no definite proof of a negative BRCA1 mutations status (Eisinger et al, 1996;Verhoog et al, 1998) or an unknown family history (Marcus et al, 1996;Johannsson et al, 1997;Lakhani et al, 1997). This might also give an underestimation of the differences under study.Recently, we completed a BRCA1 mutation screening study on a hospital-based cohort of 642 breast cancer patients not selected for family history or age at diagnosis. BRCA1-germline mutations were identified in 10 patients by using a mutation-scanning assay that would detect approximately 70% of the currently known Dutch mutation spectrum (Papelard et al, 2000). The aim of this analysis is to investigate the clinical and pathological features of these BRCA1 associated carcinomas as compared to other breast cancers in a representative sample.
METHODS
Patients and SettingPopulation From January 1984 until November 1996 all primary invasive breast cancer patients surgically treated at the Leiden University Medical Centre (LUMC) regardless of age or family history have been asked to provide a blood sample for research purposes. Mutation screening of BRCA1 was performed anonymously using an assay targeted at known founder mutations in the Dutch population. In brief, 15 PCR-amplifiers covered gene regions known to Summary Thus far, studies investigating the differences in tumour characteristics between breast cancer in BRCA1-carriers and other patients, have focused on highly selected groups of patients, potentially limiting the conclusions that can be drawn. Previously, we had identified 10 patients with BR...