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Comparative Study
. 2014 Oct;147(3):571-8.
doi: 10.1007/s10549-014-3115-3. Epub 2014 Sep 4.

High risk of in-breast tumor recurrence after BRCA1/2-associated breast cancer

Martin P Nilsson  1 , Linda Hartman, Ulf Kristoffersson, Oskar T Johannsson, Ake Borg, Karin Henriksson, Elsa Lanke, Håkan Olsson, Niklas Loman
Affiliations
Comparative Study

High risk of in-breast tumor recurrence after BRCA1/2-associated breast cancer

Martin P Nilsson et al. Breast Cancer Res Treat. 2014 Oct.

Abstract

The purpose of the study was to compare breast-conserving therapy (BCT) and mastectomy (M) in BRCA1/2 mutation carriers. Women with invasive breast cancer and a pathogenic mutation in BRCA1 or BRCA2 were included in the study (n = 162). Patients treated with BCT (n = 45) were compared with patients treated with M (n = 118). Endpoints were local recurrence as first recurrence (LR), overall survival (OS), breast cancer death, and distant recurrence. Cumulative incidence was calculated in the presence of competing risks. For calculation of hazard ratios and for multivariable analysis, cause-specific Cox proportional hazards regression was used. Compared to M, BCT was associated with an increased risk of LR in univariable analysis (HR 4.0; 95 % CI 1.6-9.8) and in multivariable analysis adjusting for tumor stage, age, and use of adjuvant chemotherapy (HR 2.9; CI 1.1-7.8). Following M, all local recurrences were seen in the first 5 years after breast cancer diagnosis. Following BCT, the rate of LR continued to be high also after the first 5 years. The cumulative incidence of LR in the BCT group was 15, 25, and 32 % after 5, 10, and 15 years, respectively. There were no significant differences between BCT and M for OS, breast cancer death, or distant recurrence. BRCA1/2 mutation carriers treated with BCT have a high risk of LR, many of which are new primary breast cancers. This must be thoroughly discussed with the patient and is an example of how rapid treatment-focused genetic testing could influence choice of treatment.

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Figures

Fig. 1
Fig. 1
Cumulative incidence for local recurrence as first recurrence by type of surgery
Fig. 2
Fig. 2
Overall survival by type of surgery
Fig. 3
Fig. 3
Cumulative incidence for breast cancer death by type of surgery
Fig. 4
Fig. 4
Cumulative incidence for distant recurrence by type of surgery
See this image and copyright information in PMC

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