Local-regional control in breast cancer patients with a possible genetic predisposition

Appropriateness of breast-conserving treatment of breast carcinoma in women with germline mutations in BRCA1 or BRCA2: a clinic-based series

BACKGROUND

Although BRCA1 and BRCA2 were identified in 1994 and 1995, respectively, to the authors' knowledge the optimal management of women with BRCA-associated breast carcinoma remains incompletely defined. The current study evaluates the appropriateness of breast-conserving therapy (BCT) in women with BRCA mutations.

METHODS

Between May 1992 and October 2003, 87 female participants in genetic testing protocols were identified who 1) were found to have deleterious germline BRCA mutations and 2) reported a history of invasive breast carcinoma that was treated with wide local excision and radiation therapy. Clinical records were reviewed and follow-up was updated.

RESULTS

The 87 subjects underwent BCT for 95 invasive breast tumors (8 women received BCT for metachronous bilateral tumors). In all 95 treated breasts, the 5-year and 10-year probabilities of metachronous ipsilateral breast carcinoma (MIBC) were 11.2% and 13.6%, respectively. Among the 87 subjects, the 5-year and 10-year probabilities of metachronous contralateral breast carcinoma (CBC) after treatment of the index tumor were 11.9% and 37.6%. No clinical factors were identified that were associated with either MIBC or CBC, including the use of tamoxifen or chemotherapy.

CONCLUSIONS

Women with BRCA-associated breast carcinoma who undergo BCT appear to have risks of MIBC that are similar to those reported for young women without known mutations. The indications for unilateral mastectomy in this group of women should be the same as those for women with nonhereditary carcinoma. However, significant risks of CBC and possibly late MIBC may prompt the serious consideration of bilateral mastectomy as a preventive measure.

Conservative Management of Breast Cancer in BRCA1/2 Mutation Carriers

Breast-conserving therapy is widely embraced for the majority of women with early-stage breast cancer, but its appropriateness in patients with germline mutations of BRCA1 and BRCA2 remains controversial. These breast cancer susceptibility genes are associated with a progressive risk of second cancers, although the prognosis of BRCA-associated breast cancer is similar to that in patients with sporadic disease. The BRCA1/2 genes are involved in the cellular response to DNA damage, but their molecular functions are not fully understood. Preclinical evidence of radiation sensitivity has led to concerns regarding radiation-induced complications in patients with BRCA1/2 mutations. The published literature on conservative management of patients with BRCA1/2 mutations is reviewed in this article. Several studies report no adverse sequelae and recurrence rates and overall survival comparable to those in sporadic disease controls. With longer follow-up, the literature suggests an increase in late second primary breast cancers, highlighting the need for preventive strategies. The potential role of tamoxifen and oophorectomy in modifying the rate of second events is discussed.

Adjuvant radiotherapy after conservative surgery for breast cancer: is it always necessary?

Breast irradiation is used to reduce the risk of within-breast recurrence following conservative surgery. This review examines factors--particularly patient age--that may be used to select patients at low risk of local failure where radiotherapy may not be necessary.

Radiation therapy in the management of breast cancer: an annual review of selected publications

Radiation oncology is essential in the management of breast cancer. Each year the scientific literature is replete with evidence of radiation's role in the treatment of this disease. The goal of this article is to motivate the reader to discuss and critically review some of these publications. The authors have made a subjective selection of clinical publications addressing radiation and breast cancer from the past 13 months. Articles were chosen on the basis of their ability to influence both current and future therapy. Some readers will no doubt disagree with our choices; however, if this disappointment generates discussion and review of these and other articles, we have achieved our goal.