Journal of Clinical Oncology, 2008 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 26, No 15S (May 20 Supplement), 2008: 536
© 2008 American Society of Clinical Oncology

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Abstract

Outcomes following breast conservation versus mastectomy in BRCA1/2 carriers with early-stage breast cancer

University of Michigan, Ann Arbor, MI; University of Utah, Salt Lake City, UT; UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ; Yale University, New Haven, CT; Sheba Medical Center, Ramut Gan, Israel; Dana-Farber Cancer Center, Boston, MA; University of Michigan, Ann Arbor, MI; Hadassah Medical Organization, Jerusalem, Israel; University of Pennsylvania, Philadelphia, PA

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Background: Although randomized trials of breast conservation (BCT) and mastectomy (M) have been conducted in early- stage breast cancer and proven the equivalence of these therapies in sporadic disease, similar trials have not been nor are likely to be performed in women with early-stage breast cancer associated with a BRCA1/2 mutation. We presently report outcomes in women prospectively followed with BRCA1/2-associated breast cancer treated locally with M vs. breast-conserving surgery and radiotherapy (RT). Methods: Investigators from 8 institutions in the US and Israel identified in their databases women with nonmetastatic breast cancer and deleterious BRCA1/2 mutations who consented to longitudinal follow-up. 160 patients were identified who underwent BCT and RT; 213 underwent M (60 with RT; 148 without; 5 unknown) as local therapy. Tumor and treatment characteristics were compared by cohort, and rates of local failure/new cancers and distant failure, contralateral breast cancers (CBC), and survival are reported at 15 years. Results: With mean follow-up of 9.9 and 10.1 years for BCT and M cohorts respectively, 15-year actuarial rates of local recurrence/new cancers were 21.5% following BCT vs. 7.1% for M (p=0.0043; HR 3.1). Rates of distant failure were comparable by cohort, with 15-year estimates of 11.2% and 12.7%, respectively (p=0.29). 15-year rates of CBC were 47.9% for BCT, 43% for M without RT, and 33% for M with RT (p=0.77). RT was not associated with an increased risk of CBC on univariate analysis. Breast-cancer specific and overall survivals were not significantly different by cohort (p=0.85 and p=0.55), respectively. Conclusions: With long-term follow-up, BRCA1/2 carriers with breast cancer are at significantly greater risk for local failure/new cancers following BCT vs. M but this did not translate into differences in breast-cancer specific and overall survival. Moreover, 15-year rates of CBC were comparable with and without RT, suggesting no detectable increase in CBC from scatter RT. These results should be discussed with BRCA1/2 carriers with breast cancer as they consider their local treatment options.

No significant financial relationships to disclose.

Abstract presentation from the 2008 ASCO Annual Meeting