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Published on: August 12, 2015
Survival from breast cancer in women with a BRCA2 mutation by treatment
D Gareth Evans1, Kelly-Anne Phillips2,3,4, Roger L Milne4,5,6
1Genomic Medicine, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
Background:
The impact of various breast-cancer treatments on patients with a BRCA2 mutation has not been studied. We sought to estimate the impact of bilateral oophorectomy and other treatments on breast cancer-specific survival among patients with a germline BRCA2 mutation.
Methods:
We identified 664 women with stage I-III breast cancer and a BRCA2 mutation by combining five different datasets (retrospective and prospective). Subjects were followed for 7.2 years from diagnosis to death from breast cancer. Tumour characteristics and cancer treatments were patient-reported and derived from medical records. Predictors of survival were determined using Cox proportional hazard models, adjusted for other treatments and for prognostic features.
Results:
The 10-year breast-cancer survival for ER-positive patients was 78.9% and for ER-negative patients was 82.3% (adjusted HR = 1.23 (95% CI, 0.62-2.45, p = 0.55)). The 10-year breast-cancer survival for women who had a bilateral oophorectomy was 89.1% and for women who did not have an oophorectomy was 59.0% (adjusted HR = 0.45; 95% CI, 0.28-0.72, p = 0.001). The adjusted hazard ratio for chemotherapy was 0.83 (95% CI, 0.65-1.53: p = 0.56).
Conclusions:
For women with breast cancer and a germline BRCA2 mutation, positive ER status does not predict superior survival. Oophorectomy is associated with a reduced risk of death from breast cancer and should be considered in the treatment plan.
Insights
Bilateral oophorectomy significantly improves breast cancer survival for women with a BRCA2 mutation. This treatment, unlike ER status, is a key factor in reducing breast cancer mortality in this population.
Area of Science:
- Oncology
- Genetics
- Surgical Oncology
Background:
- Limited research exists on breast cancer treatment outcomes for BRCA2 mutation carriers.
- Understanding treatment impact is crucial for personalized medicine in hereditary breast cancer.
Purpose of the Study:
- To evaluate the effect of bilateral oophorectomy and other treatments on breast cancer-specific survival.
- To identify prognostic factors for survival in patients with germline BRCA2 mutations.
Main Methods:
- Retrospective and prospective data from 664 women with stage I-III breast cancer and BRCA2 mutations were combined.
- Survival analysis was performed using Cox proportional hazard models, adjusting for prognostic features and treatments.
- Patient-reported and medical record data were used for tumor characteristics and treatment information.
Main Results:
- Bilateral oophorectomy was associated with a significant reduction in breast cancer mortality (adjusted HR=0.45; p=0.001).
- Estrogen receptor (ER) status did not significantly predict breast cancer survival (adjusted HR=1.23; p=0.55).
- Chemotherapy showed a non-significant trend towards improved survival (adjusted HR=0.83; p=0.56).
Conclusions:
- Oophorectomy is a critical intervention for improving survival in BRCA2-mutated breast cancer patients.
- ER status is not a reliable predictor of survival in this cohort.
- Oophorectomy should be strongly considered in the management of breast cancer in women with BRCA2 mutations.
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