Ten-Year Survival in Patients With <i>BRCA1</i>-Negative and <i>BRCA1</i>-Positive Breast Cancer

Huzarski, Tomasz; Byrski, Tomasz; Gronwald, Jacek; Górski, Bohdan; Domagała, Paweł; Cybulski, Cezary; Oszurek, Oleg; Szwiec, Marek; Gugała, K; Stawicka, Małgorzata; Morawiec, Zbigniew; Mierzwa, Tomasz; Janiszewska, Hanna; Kilar, Ewa; Marczyk, Elżbieta; Kozak-Klonowska, Beata; Siołek, Monika; Surdyka, Dariusz; Wiśniowski, Rafał; Posmyk, Michał; Sun, Ping; Lubiński, Jan; Narod, Steven A.

doi:10.1200/jco.2012.45.3571

Cited by 120 publications

(101 citation statements)

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“…Impact of oophorectomy on mortality results in large part from reduction in the incidence of ovarian, tubal, and peritoneal cancers-but there is an important component from reducing breast cancer incidence and and once the cancer is diagnosed, it reduces patient case fatality by 70%. 8 Average age at cohort entry was 46.0 years, and women were observed until a mean age of 51.6 years. It is expected that in young women, noncancer causes of death will be rare, and reduction in all-cause mortality associated with oophorectomy may attenuate as the women age and other causes of death emerge.…”

Section: Discussionmentioning

confidence: 99%

Impact of Oophorectomy on Cancer Incidence and Mortality in Women With a BRCA1 or BRCA2 Mutation

Finch

Lubiński

Møller

et al. 2014

JCO

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Purpose The purposes of this study were to estimate the reduction in risk of ovarian, fallopian tube, or peritoneal cancer in women with a BRCA1 or BRCA2 mutation after oophorectomy, by age of oophorectomy; to estimate the impact of prophylactic oophorectomy on all-cause mortality; and to estimate 5-year survival associated with clinically detected ovarian, occult, and peritoneal cancers diagnosed in the cohort. Patients and Methods Women with a BRCA1 or BRCA2 mutation were identified from an international registry; 5,783 women completed a baseline questionnaire and ≥ one follow-up questionnaires. Women were observed until either diagnosis of ovarian, fallopian tube, or peritoneal cancer, death, or date of most recent follow-up. Hazard ratios (HRs) for cancer incidence and all-cause mortality associated with oophorectomy were evaluated using time-dependent survival analyses. Results After an average follow-up period of 5.6 years, 186 women developed either ovarian (n = 132), fallopian (n = 22), or peritoneal (n = 32) cancer, of whom 68 have died. HR for ovarian, fallopian, or peritoneal cancer associated with bilateral oophorectomy was 0.20 (95% CI, 0.13 to 0.30; P < .001). Among women who had no history of cancer at baseline, HR for all-cause mortality to age 70 years associated with an oophorectomy was 0.23 (95% CI, 0.13 to 0.39; P < .001). Conclusion Preventive oophorectomy was associated with an 80% reduction in the risk of ovarian, fallopian tube, or peritoneal cancer in BRCA1 or BRCA2 carriers and a 77% reduction in all-cause mortality.

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Section: Discussionmentioning

confidence: 99%

Impact of Oophorectomy on Cancer Incidence and Mortality in Women With a BRCA1 or BRCA2 Mutation

Finch

Lubiński

Møller

et al. 2014

JCO

Self Cite

571

406

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“…We have recently shown that oophorectomy is associated with improved survival in BRCA1 carriers treated for early-onset breast cancer. 35 It is important to establish whether the preservation of ovarian function in young women with breast cancer and a BRCA mutation has an adverse impact on disease recurrence.…”

Section: Proportion With Induced Amenorrheamentioning

confidence: 99%

Chemotherapy-Induced Amenorrhea in Patients With Breast Cancer With a BRCA1 or BRCA2 Mutation

Valentini

Finch

Lubiński³

et al. 2013

JCO

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A B S T R A C T PurposeTo determine the likelihood of long-term amenorrhea after treatment with chemotherapy in women with breast cancer who carry a BRCA1 or BRCA2 mutation. Patients and MethodsWe conducted a multicenter survey of 1,954 young women with a BRCA1 or BRCA2 mutation who were treated for breast cancer. We included premenopausal women who were diagnosed with invasive breast cancer between 26 and 47 years of age. We determined the age of onset of amenorrhea after breast cancer for women who were and were not treated with chemotherapy, alone or with tamoxifen. We considered chemotherapy-induced amenorrhea to have occurred when the patient experienced Ն 2 years of amenorrhea, commencing within 2 years of initiating chemotherapy, with no resumption of menses. ResultsOf the 1,426 women who received chemotherapy, 35% experienced long-term amenorrhea. Of the 528 women who did not receive chemotherapy, 5.3% developed long-term amenorrhea. The probabilities of chemotherapy-induced amenorrhea were 7.2% for women diagnosed before age 30 years, 33% for women age 31 to 44 years, and 79% for women diagnosed after age 45 years (P trend Ͻ .001). The probability of induced amenorrhea was higher for women who received tamoxifen than for those who did not (52% v 29%; P Ͻ .001). ConclusionAge at treatment and use of tamoxifen are important predictors of chemotherapy-induced amenorrhea in women who carry a BRCA1 or BRCA2 mutation. The risk of induced long-term amenorrhea does not seem to be greater among mutation carriers than among women who do not carry a mutation.

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“…In fact, in 1997, a randomized trial that enrolled 852 high-risk patients treated with combined CMF, chemotherapy, and radiation therapy, showed a 10-year OS rate of 54% (15). In 2013, another trial with 3,312 patients that did not carry BRCA1, were treated with anthracycline-taxane-based chemotherapy and showed a 10-year OS rate of 82.2% (16).…”

Section: Discussionmentioning

confidence: 99%

LH-RH analogues in the treatment of young women with early breast cancer: Long-term follow-up of a phase II study

Recchia¹,

Necozione

Bratta³

et al. 2014

International Journal of Oncology

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Abstract. To prevent premature ovarian failure (POF), high-risk, premenopausal women with early breast cancer were given a luteinizing-hormone releasing hormone (LH-RH) analogue during adjuvant chemotherapy. After an adriamycin-based regimen, patients received radiation therapy concomitant with cyclophosphamide, methotrexate and 5-fluorouracil. An aromatase inhibitor was given to patients positive for the estrogen receptor (ER + ). The median age was 43 years (range, 26-45). Among 200 consecutive patients, 46% had no axillary node, and 54% had a mean of 5.4 positive nodes (range, 1-25); 56% were ER + , 44% were estrogen receptor negative (ER -), 13% were triple negative, and 20 had tumors positive for the oncogene, c-erb-B2 (identified with fluorescent in situ hybridization). After a median follow-up of 105 months (range, 65-180), no patient under 40 years old exhibited POF, while 44% of patients over 40 years old exhibited POF. Eight pregnancies were recorded: 7 at term and 1 voluntary interruption. The 10-year disease-free survival and overall survival rates were 85 and 91%, respectively. These data showed that, in premenopausal patients with early breast cancer, the addition of an LH-RH analogue to adjuvant chemotherapy was well tolerated, prevented POF, and was associated with excellent disease-free survival and overall survival rates. IntroductionBreast cancer in young women is associated with a poor prognosis; in the absence of adjuvant treatment, approximately half of the patients will die of metastatic disease. Ovarian ablation was the first described form of endocrine therapy for treating advanced breast cancer (1). Previous trials have also suggested that ovarian ablation with surgery or radiation therapy could reduce the risk of recurrence in young premenopausal women (2). However, in recent years, adjuvant chemotherapy has become the standard treatment for young premenopausal patients with breast cancer that have a high risk of systemic disease (3).One important aspect of chemotherapy is the toxicity, which can induce premature ovarian failure (POF). POF was reported in 68% of women after cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) regimens, and a POF higher rate was observed in women treated with anthracycline-based regimens (4). This may be a serious problem for young women in reproductive ages. Preserving fertility during adjuvant chemotherapy has been an ongoing endeavor, since 1987 (data on file), when a nulliparous, just married, 33-year-old woman, with high risk of breast cancer underwent anthracycline-based adjuvant chemotherapy. She was treated with buserelin, a luteinizing-hormone releasing hormone (LH-RH) agonist, once daily in a nasal spray, during 6 months of chemotherapy. After chemotherapy and radiation therapy, she completed two full term pregnancies.In the following years, we conducted a clinical trial in premenopausal patients with early breast cancer, where another LH-RH agonist, goserelin was given subcutaneously (3.6 mg) every 28 days for 1 year, in addition to adjuv...

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Ten-Year Survival in Patients With BRCA1-Negative and BRCA1-Positive Breast Cancer

Abstract: The 10-year survival rate among women with breast cancer and a BRCA1 mutation is similar to that of patients without a BRCA1 mutation. Among women with a BRCA1 mutation, survival was much improved after oophorectomy.

Cited by 120 publications

References 20 publications

Impact of Oophorectomy on Cancer Incidence and Mortality in Women With a BRCA1 or BRCA2 Mutation

Impact of Oophorectomy on Cancer Incidence and Mortality in Women With a BRCA1 or BRCA2 Mutation

Chemotherapy-Induced Amenorrhea in Patients With Breast Cancer With a BRCA1 or BRCA2 Mutation

LH-RH analogues in the treatment of young women with early breast cancer: Long-term follow-up of a phase II study

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