Breast Conservation Surgery Safe With BRCA1 Breast Cancer

Paula Moyer, MA

March 18, 2004

March 18, 2004 (Hamburg, Germany) — Breast conservation surgery along with radiotherapy is safe in women who carry the BRCA1 or BRCA2 germline mutation and develop breast cancer, as long as the women receive lifelong follow-up, according to a French study presented here at the Fourth European Breast Cancer Conference.

"Carriers of this mutation have no increased risk of recurrence in comparison to women with other types of breast cancer, although they are at risk of cancer in the contralateral breast," principal investigator Youlia Kirova, MD, told Medscape. "Therefore, we can treat these patients conservatively, as long as we follow them closely." Dr. Kirova, an assistant professor of radiotherapy at the Institute Curie in Paris, France, added that age was the key risk factor for recurrence, and that patients' risk increased 6% with each decreasing year of age.

The investigators conducted the study because these mutations are associated with a strong risk of breast cancer, which have in some physicians' hands precluded breast-conserving treatments. Of 131 patients who had a total of 136 tumors, the investigators screened for the BRCA1 and BRCA2 genes germline mutation. Patients had a family history of breast or ovarian cancer or both, and all had been treated with breast conservation therapy.

The investigators assessed tumor features as well as rates of breast cancer recurrence and the development of contralateral breast cancer. Tumor features and the rates of these events in BRCA mutation carriers were compared with those of noncarriers who also had a positive family history. The investigators then compared the findings in the 131 patients to those of 261 breast cancer patients who had a negative family history, and the 136 tumors in patients with a positive family history were compared with 271 control tumors.

The investigators found BRCA1 and BRCA2 mutations in 20.6% of patients with a positive family history and in 21.3% of their tumors. Of these, 19 patients with a total of 21 tumors had the BRCA1 mutation and eight patients with eight tumors had the BRCA2 mutation. The tumors in such patients were more likely to have grade III and estrogen receptor-negative tumors than were the tumors in both noncarriers and control patients (P = .005 for both). All 392 patients were followed for a median of 8.75 years.

Dr. Kirova and colleagues found no significant differences in recurrence among BRCA1 and BRCA2 tumors and controls, among tumors in carriers and noncarriers with a family history, or noncarriers and controls. The carriers were more likely to go on to develop contralateral breast cancer than were control patients (P = .0003), as were noncarriers compared with control patients (P = .0034). Carriers were also more at risk of contralateral breast cancer than were noncarriers (P = .02).

The findings show that breast conservation surgery with radiation is a safe and feasible therapy to offer patients with either of these mutations, Dr. Kirova said.

Fourth European Breast Cancer Conference: Abstract 329. Presented March 18, 2004.

Reviewed by Gary D. Vogin, MD

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