Local therapy in BRCA1 and BRCA2 mutation carriers with operable breast cancer: comparison of breast conservation and mastectomy

Abstract

Purpose Women with BRCA1 and BRCA2 mutations have an elevated risk of breast cancer and ovarian cancer, but also of developing second primary breast cancer. BRCA1/2 mutation carriers with breast cancer must choose between breast conservation (BCT) and mastectomy (M) yet data on outcomes are limited. The purpose of this study is to compare BCT to M in BRCA1/2 carriers. Methods 655 women with BRCA1/2 mutations diagnosed with breast cancer and treated with BCT (n=302) or M (n=353) were identified and underwent follow up to assess local, regional and systemic recurrence. Results Local failure as first failure was significantly more likely in those treated with BCT compared to M, with a cumulative estimated risk of 23.5% vs. 5.5%, respectively, at 15 years (p<0.0001); 15-year estimates in carriers treated with BCT and chemotherapy was 11.9% (p=0.08 when compared to M). Most events appeared to be second primary cancers rather than failure to control the primary tumor. The risk of contralateral breast cancer was high in all groups, exceeding 40%, but was not statistically significantly different by use of adjuvant radiotherapy (RT) or not, suggesting no added risk from scatter RT at 10 and 15 years. There were no differences seen in regional or systemic recurrences between the BCT and M groups, and no difference in overall survival. Conclusions BRCA1/2 mutation carriers with breast cancer have similar survivals whether treated with M or BCT. However, women undergoing BCT have an elevated risk of a second in-breast event that is significantly reduced in the presence of chemotherapy. Contralateral breast cancer events are very common.

Breast cancer in young women

“…The risk for local recurrence is obviously greater if conservative treatment rather than radical management was applied, although type of surgery in the latter approach has no correlation with the overall survival [29]. Current data indicate that radiation as an element of conservative management does not elevate the risk for carcinogenesis in BRCA carriers as compared to other BC patients.…”

Relevance and efficacy of breast cancer screening inBRCA1andBRCA2mutation carriers above 60 years: A national cohort study

“…23,24 Furthermore, most BRCA1/2 mutation carriers with breast tissue present at age 60 in our study did not have a history of breast cancer. Older age at onset, also in BRCA1/2 mutation carriers, can be a family trait.…”

Genetic Advances in Oncology and the Effects on Nursing Roles

“…[36,37] Meme kanseri tanısı konulan ve BRCA mutasyonu olan kadınların 15 yıl için kümülatif aynı memede kanser görülme riskleri, konservatif meme cerrahisi sonrası %23.5 iken, mastektomi sonrası bu riskin %5.5'lere düştüğü belirtilmektedir. [38] Herediter Kanser Riskinin Belirlenmesi Kalıtımsal kanser riskinin belirlenmesi, risk altındaki bireylere genetik danışmanlık verilmesi ve genetik test yapılması sonucu elde edilen verilere göre risk azaltıcı stratejilerin uygulanması, kanser mortalite ve morbiditesinin azaltılmasında giderek önem kazanmaktadır. [39] Kademeli genetik tarama (cascade genetic screening), bir ailede ilk olarak genetik danışmana başvuran ve herediter meme-over kanseri, Lynch sendromu gibi herediter kanser tanısı konulan bireylerin (proband) risk altındaki biyolojik akrabalarının tanımlanması ve test edilmesi sürecidir.…”