Alexandra J van den Broek1,2, Marjanka K Schmidt1,2, Laura J van 't Veer2, Hester S A Oldenburg3, Emiel J Rutgers3, Nicola S Russell4, Vincent T H B M Smit5, Adri C Voogd6,7, Linetta B Koppert8, Sabine Siesling6,9, Jan J Jobsen10, Pieter J Westenend11, Flora E van Leeuwen1, Rob A E M Tollenaar12. 1. Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands. 2. Division of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands. 3. Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands. 4. Department of Radiotherapy, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands. 5. Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands. 6. Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands. 7. Department of Epidemiology, Maastricht University Medical Centre, Maastricht, The Netherlands. 8. Department of Oncological Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. 9. Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands. 10. Department of Radiation Oncology, Medisch Spectrum Twente, Enschede, The Netherlands. 11. Laboratory for Pathology, Dordrecht, The Netherlands. 12. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Abstract
OBJECTIVE: To investigate the effects of different types of surgery on breast cancer prognosis in germline BRCA1/BRCA2 mutation carriers compared with noncarriers. SUMMARY OF BACKGROUND DATA: Although breast-conserving therapy (breast-conserving surgery followed by radiotherapy) has been associated with more local recurrences than mastectomy, no differences in overall survival have been found in randomized trials performed in the general breast cancer population. Whether breast-conservation can be safely offered to BRCA1/2 mutation carriers is debatable. METHODS: The study comprised a cohort of women with invasive breast cancer diagnosed <50 years and treated between 1970 and 2003 in 10 Dutch centers. Germline DNA for BRCA1/2 testing of most-prevalent mutations (covering ∼61%) was mainly derived from paraffin-blocks. Survival analyses were performed taking into account competing risks. RESULTS: In noncarriers (N = 5820), as well as in BRCA1 (N = 191) and BRCA2 (N = 70) mutation carriers, approximately half of the patients received breast-conserving therapy. Patients receiving mastectomy followed by radiotherapy had prognostically worse tumor characteristics and more often received systemic therapy. After adjustment for these potential confounders, patients who received breast-conserving therapy had a similar overall survival compared with patients who received mastectomy, both in noncarriers (hazard ratio [HR] = 0.95, confidence interval [CI] = 0.85-1.07, P = 0.41) and BRCA1 mutation carriers (HR = 0.80, CI = 0.42-1.51, P = 0.50). Numbers for BRCA2 were insufficient to draw conclusions. The rate of local recurrences after breast-conserving therapy did not differ between BRCA1 carriers (10-year risk = 7.3%) and noncarriers (10-year risk = 7.9%). CONCLUSION: Our results, together with the available literature, provide reassurance that breast-conserving therapy is a safe local treatment option to offer to BRCA1 mutation carriers with invasive breast cancer.
OBJECTIVE: To investigate the effects of different types of surgery on breast cancer prognosis in germline BRCA1/BRCA2 mutation carriers compared with noncarriers. SUMMARY OF BACKGROUND DATA: Although breast-conserving therapy (breast-conserving surgery followed by radiotherapy) has been associated with more local recurrences than mastectomy, no differences in overall survival have been found in randomized trials performed in the general breast cancer population. Whether breast-conservation can be safely offered to BRCA1/2 mutation carriers is debatable. METHODS: The study comprised a cohort of women with invasive breast cancer diagnosed <50 years and treated between 1970 and 2003 in 10 Dutch centers. Germline DNA for BRCA1/2 testing of most-prevalent mutations (covering ∼61%) was mainly derived from paraffin-blocks. Survival analyses were performed taking into account competing risks. RESULTS: In noncarriers (N = 5820), as well as in BRCA1 (N = 191) and BRCA2 (N = 70) mutation carriers, approximately half of the patients received breast-conserving therapy. Patients receiving mastectomy followed by radiotherapy had prognostically worse tumor characteristics and more often received systemic therapy. After adjustment for these potential confounders, patients who received breast-conserving therapy had a similar overall survival compared with patients who received mastectomy, both in noncarriers (hazard ratio [HR] = 0.95, confidence interval [CI] = 0.85-1.07, P = 0.41) and BRCA1 mutation carriers (HR = 0.80, CI = 0.42-1.51, P = 0.50). Numbers for BRCA2 were insufficient to draw conclusions. The rate of local recurrences after breast-conserving therapy did not differ between BRCA1 carriers (10-year risk = 7.3%) and noncarriers (10-year risk = 7.9%). CONCLUSION: Our results, together with the available literature, provide reassurance that breast-conserving therapy is a safe local treatment option to offer to BRCA1 mutation carriers with invasive breast cancer.
Authors: Daniele Giardiello; Maartje J Hooning; Michael Hauptmann; Renske Keeman; B A M Heemskerk-Gerritsen; Heiko Becher; Carl Blomqvist; Stig E Bojesen; Manjeet K Bolla; Nicola J Camp; Kamila Czene; Peter Devilee; Diana M Eccles; Peter A Fasching; Jonine D Figueroa; Henrik Flyger; Montserrat García-Closas; Christopher A Haiman; Ute Hamann; John L Hopper; Anna Jakubowska; Floor E Leeuwen; Annika Lindblom; Jan Lubiński; Sara Margolin; Maria Elena Martinez; Heli Nevanlinna; Ines Nevelsteen; Saskia Pelders; Paul D P Pharoah; Sabine Siesling; Melissa C Southey; Annemieke H van der Hout; Liselotte P van Hest; Jenny Chang-Claude; Per Hall; Douglas F Easton; Ewout W Steyerberg; Marjanka K Schmidt Journal: Breast Cancer Res Date: 2022-10-21 Impact factor: 8.408
Authors: Kristin E Rojas; Elizabeth Butler; Julie Gutierrez; Rebecca Kwait; Jessica Laprise; Jennifer Scalia Wilbur; Sarah Spinette; Christina A Raker; Katina Robison; Robert Legare; Jennifer Gass; Ashley Stuckey Journal: Gland Surg Date: 2019-06
Authors: Daniele Giardiello; Ewout W Steyerberg; Michael Hauptmann; Muriel A Adank; Delal Akdeniz; Carl Blomqvist; Stig E Bojesen; Manjeet K Bolla; Mariël Brinkhuis; Jenny Chang-Claude; Kamila Czene; Peter Devilee; Alison M Dunning; Douglas F Easton; Diana M Eccles; Peter A Fasching; Jonine Figueroa; Henrik Flyger; Montserrat García-Closas; Lothar Haeberle; Christopher A Haiman; Per Hall; Ute Hamann; John L Hopper; Agnes Jager; Anna Jakubowska; Audrey Jung; Renske Keeman; Iris Kramer; Diether Lambrechts; Loic Le Marchand; Annika Lindblom; Jan Lubiński; Mehdi Manoochehri; Luigi Mariani; Heli Nevanlinna; Hester S A Oldenburg; Saskia Pelders; Paul D P Pharoah; Mitul Shah; Sabine Siesling; Vincent T H B M Smit; Melissa C Southey; William J Tapper; Rob A E M Tollenaar; Alexandra J van den Broek; Carolien H M van Deurzen; Flora E van Leeuwen; Chantal van Ongeval; Laura J Van't Veer; Qin Wang; Camilla Wendt; Pieter J Westenend; Maartje J Hooning; Marjanka K Schmidt Journal: Breast Cancer Res Date: 2019-12-17 Impact factor: 6.466