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- Title
Clinical Outcomes for BRCA Pathogenic Variant Carriers With Breast Cancer Undergoing Breast Conservation.
- Authors
Wanis, Kerollos Nashat; Kuerer, Henry M.; Sun, Susie X.; Hunt, Kelly K.; Glencer, Alexa C.; Teshome, Mediget; Lucci, Anthony; Weiser, Roi; Johnson, Helen; Smith, Benjamin D.; Gutierrez, Angelica M.; Shaitelman, Simona F.; Arun, Banu K.
- Abstract
Key Points: Question: What are the long-term clinical outcomes of patients with BRCA-associated breast cancer who undergo breast-conserving therapy (BCT)? Findings: In this cohort study of 172 women with BRCA-associated breast cancer who underwent BCT, participants had above-average risks of ipsilateral and contralateral breast cancer events; however, if surviving to 10 years, most never experienced either event and were bilateral mastectomy free. Meaning: The long-term cancer event risks and the probability of future bilateral mastectomy can help inform patients with BRCA-associated breast cancer choosing breast conservation. Importance: Although most women with BRCA-associated breast cancer choose bilateral mastectomy, current guidelines support breast-conserving therapy as an option. As the indications for genetic testing expand and targeted therapies emerge, understanding the outcomes of breast-conserving therapy in the population of patients choosing breast conservation is important. Objective: To describe the clinical outcomes of women with BRCA-associated breast cancer who were treated with breast-conserving therapy, including the risks of ipsilateral and contralateral cancer events and bilateral mastectomy-free survival. Design, Setting, and Participants: This cohort study conducted at a single-institution academic national comprehensive cancer center included 172 women identified from a prospectively maintained database who had pathogenic BRCA1/2 variants and were treated with breast-conserving therapy from January 1, 1977, to December 31, 2021. Main Outcomes and Measures: Clinical and pathologic characteristics for patients with BRCA1 and BRCA2 were compared, and estimates of overall survival, bilateral mastectomy-free survival, distant disease-free survival, risk of ipsilateral breast cancer, and risk of contralateral cancer were computed. Results: The cohort included 172 women (mean [SD] age, 47.1 [11.7] years), with 42 (24.4%) receiving a diagnosis of breast cancer prior to 40 years of age. Compared with BRCA2 variant carriers (80 [46.5%]), women with BRCA1 variants (92 [53.5%]) were younger at breast cancer diagnosis and tended to have more advanced tumors, which were more likely to be hormone receptor negative and higher grade. At a median follow-up of 11.8 years (IQR, 5.7-18.2 years), estimates of 10-year survival and risk were: overall survival, 88.5% (95% CI, 83.1%-94.2%); bilateral mastectomy-free survival, 70.7% (95% CI, 63.3%-78.9%); risk of an ipsilateral breast cancer event, 12.2% (95% CI, 5.8%-18.2%); and risk of contralateral cancer, 21.3% (95% CI, 13.3%-28.6%). Risks continued to increase after 10 years of follow-up. Conclusions and Relevance: In this cohort study, although women with breast cancer and pathogenic BRCA1/2 variants treated with breast-conserving therapy had above-average risks of ipsilateral and contralateral breast cancer events, most did not have another cancer event and remained bilateral mastectomy free. These findings may be useful for informing patients with BRCA variants choosing breast conservation. This cohort study describes the clinical outcomes of women with BRCA1/2 variant–associated breast cancer who were treated with breast-conserving therapy, including the risk of ipsilateral and contralateral cancer events and bilateral mastectomy-free survival.
- Subjects
BREAST tumor risk factors; BREAST tumor treatment; RISK assessment; SELF-evaluation; RESEARCH funding; TREATMENT effectiveness; MULTIVARIATE analysis; GENETIC polymorphisms; LONGITUDINAL method; METASTASIS; KAPLAN-Meier estimator; LOG-rank test; RACE; STATISTICS; MASTECTOMY; PROGRESSION-free survival; CONFIDENCE intervals; DATA analysis software; OVERALL survival; PROPORTIONAL hazards models; REGRESSION analysis
- Publication
JAMA Network Open, 2024, Vol 7, Issue 6, pe2418486
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.18486