Purpose:To evaluate acute toxicity induced by chemotherapy for breast cancer in a retrospective study of 62 BRCA1/2 mutation carriers matched 1:1with women who had treatment for sporadic disease in the United Kingdom between 1983 and 2003. Experimental Design: All participants were interviewed by one of two researchers using standardized questionnaires, and their medical records were reviewed by one research nurse.The two main regimens received were cyclophosphamide, methotrexate, and fluorouracil and fluorouracil, epirubicin, and cyclophosphamide. The proportion of cases and controls receiving anthracyclinebased treatment was equivalent, but fewer BRCA1 cases received this treatment than did BRCA2 mutation carriers. Toxicity was documented using the Eastern Cooperative Oncology Group Common Toxicity Criteria for hematologic, infective, and gastrointestinal toxicities. No increase in toxicity was seen in BRCA1/2 mutation carriers. Results: The only significant difference was that neutropenia was less evident in BRCA2 mutation carriers than in either BRCA1 mutation carriers or controls. As a result, there was no requirement for dose reduction among BRCA2 mutation carriers, in contrast to 10 of 39 BRCA1 carriers and 16 of 62 controls (P = 0.02). Conclusions:This result has implications for therapy and indicates that women with mutations in BRCA1 and BRCA2 may be given the same doses of chemotherapy as noncarriers.BRCA1 and BRCA2 mutation carriers face a high risk of both breast and ovarian cancer due to mutations in these DNA double-strand break repair genes. Adjuvant breast cancer treatments of chemotherapy and radiotherapy rely on killing cells by mechanisms which include inducing DNA damage, affecting cell cycle checkpoints, or cell division, as reviewed by Kennedy et al. (1). The BRCA1 and BRCA2 genes have been shown to be integrally involved in these pathways, particularly in the repair of DNA double-strand breaks by homologous recombination. It is important to examine the effects of radiation and chemotherapeutic agents in BRCA1 and BRCA2 carriers as one would expect that they could have a greater incidence of normal tissue toxicity from both modalities compared with women with sporadic disease. The accompanying report evaluates the late effects of radiation in a case-control study of BRCA1/2 mutation carriers and sporadic controls in the United Kingdom (17). In conjunction with that study, the toxicity of chemotherapy was also examined to address the following questions: are BRCA1/2 mutation carriers more at risk of acute toxicity from chemotherapy? Do such individuals experience more severe decreases in blood counts and chemotherapy cycle delays, and would this result in a requirement for