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

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Abstract

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 long-term outcome following BCT and M in BRCA1/2 carriers. 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. 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. In conclusion, BRCA1/2 mutation carriers with breast cancer have similar survival 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.

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Acknowledgments

This research was supported by the Breast Cancer Research Foundation (LJP, SDM); the Colebatch Clinical Research Fellowship of the Cancer Council Victoria (KAP), the National Health and Medical Research Council (NHMRC) of Australia (#145684, 288704, 454508) and grants from the National Breast Cancer Foundation, the NHMRC and by the Queensland Cancer Fund, the Cancer Councils of New South Wales, Victoria, Tasmania and South Australia, and the Cancer Foundation of Western Australia (kConFab); Susan G. Komen Breast Cancer Foundation (BGH); Dana Farber/Harvard Cancer Center SPORE in Breast Cancer (JEG); and Cancer Genetics Network (HHSN21620074400C) (SMD). We thank follow-up study investigators, research nurses and staff at kConFab and all study sites, the heads and staff of the Australian and New Zealand Family Cancer Clinics, and the families who contribute to kConFab and to this international collaboration.

Conflict of interest statement

No authors have a conflict of interest with the content of this manuscript.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Michigan Comprehensive Cancer Center, 1500 East Medical Center Drive Room 4308, Ann Arbor, MI, 48109, USA

    Lori J. Pierce

  2. Division of Hematology and Medical Oncology, Peter MacCallum Cancer Center and Department of Medicine, St. Vincent’s Hospital, The University of Melbourne, Melbourne, VIC, Australia

    Kelly-Anne Phillips

  3. Biostatistics Unit, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA

    Kent A. Griffith

  4. Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    Saundra Buys

  5. Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    David K. Gaffney

  6. Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA

    Meena S. Moran

  7. Department of Radiation Oncology, Cancer Institute of New Jersey UMDNJ-RWJMS, New Brunswick, NJ, USA

    Bruce G. Haffty

  8. Department of Oncology, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel

    Merav Ben-David & Bella Kaufman

  9. Dana Farber Cancer Institute, Harvard University, Boston, MA, USA

    Judy E. Garber

  10. Division of Medical Oncology, Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA

    Sofia D. Merajver

  11. Servei d’Oncologia Médica, Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Judith Balmaña

  12. Department of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Amichay Meirovitz

  13. Division of Medical Oncology, Department of Internal Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA

    Susan M. Domchek

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  1. Lori J. Pierce
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  2. Kelly-Anne Phillips
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  3. Kent A. Griffith
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  4. Saundra Buys
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  5. David K. Gaffney
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  6. Meena S. Moran
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  7. Bruce G. Haffty
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  8. Merav Ben-David
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  9. Bella Kaufman
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  10. Judy E. Garber
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  12. Judith Balmaña
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  13. Amichay Meirovitz
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  14. Susan M. Domchek
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Correspondence to Lori J. Pierce.

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Pierce, L.J., Phillips, KA., Griffith, K.A. et al. Local therapy in BRCA1 and BRCA2 mutation carriers with operable breast cancer: comparison of breast conservation and mastectomy. Breast Cancer Res Treat 121, 389–398 (2010). https://doi.org/10.1007/s10549-010-0894-z

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  • DOI: https://doi.org/10.1007/s10549-010-0894-z

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