Familial versus Sporadic Breast Cancer: Different Treatments for Similar Tumors?

Abstract

Objective: It is unclear if and to what extent family history of breast/ovarian cancer or BRCA1/2-mutation carriership influences breast cancer treatment strategy. We investigated whether treatment differed between patients from BRCA1/2 families and those unselected for family history. Methods: We included 478 BRCA1/2-related patients referred for genetic testing before or after diagnosis. Two references were used: 13,498 population-based and 6896 hospital-based patients. Surgical treatment and adjuvant chemotherapy use was analyzed using logistic regression models, stratified by tumor size, nodal status, age at and period of diagnosis, and estrogen receptor status (ER). Results: BRCA1/2 cases aged 35 -52 years at diagnosis and/or with tumors < 2 cm were more likely to have undergone a modified radical mastectomy (Odd Ratios (OR) ranging from 2.8 to 5.1) compared to the references. This effect was most pronounced in patients treated after 1995 (OR 5.7 to 10.3). Compared to the reference groups, chemotherapy was more often administered to BRCA1 and ER-negative BRCA1/2-cases irrespective of age and nodal status (OR 1.9 E. G. Engelhardt et al. 88to 24.3). Conclusion: After 1995 treatment of BRCA1/2-associated patients consisted notably of more mastectomies and adjuvant chemotherapy than their population-based counterparts with the same tumor characteristics. There is a need to be aware of such differences in daily practice and interpretation of survival studies on BRCA1/2 mutation carriers.

Breast Cancer Survival of BRCA1/BRCA2 Mutation Carriers in a Hospital-Based Cohort of Young Women

“…BRCA1/2 mutation carriers in our study that were not referred to the Clinical Genetic Center and those diagnosed before 1995 had the most pronounced worse survival compared with noncarriers in unadjusted analyses. This could partially be explained by survivor bias for referral to the Clinical Genetic Center and/or due to different treatment or preventive surgery decisions related to family history and/or knowledge of BRCA1/2 mutation carriership (37). However, our design and comprehensive data allowed us to adjust sufficiently for these factors in the multivariable analyses, showing no remaining differences between referred and nonreferred patients.…”

Galangin/β-Cyclodextrin Inclusion Complex as a Drug-Delivery System for Improved Solubility and Biocompatibility in Breast Cancer Treatment

“…According to Cancer Statistics 2020, BC accounts for 30% of all female cancers, with 276,480 new cases and over 42,000 expected fatalities [ 5 ]. A breast cancer gene 1 (BRCA1) or BRCA2 gene mutation is thought to be responsible for 2% to 3% of all cases of BC [ 6 ]. In several countries, limited access to affordable, high-quality cancer surgery, pathology tests, essential cancer medicines, and radiotherapy are all factors that influence poorer survival in many countries [ 7 ].…”