To investigate the effects of different types of surgery on breast cancer prognosis
in germline BRCA1
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.
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.
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%).
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