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Safety of breast conservation therapy in BRCA1 and BRCA2 cancers


T. E. Alpert a1 and B. G. Haffty a2c1
a1 Department of Radiation Oncology, Upstate Medical University, Syracuse, NY, USA
a2 Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA.

Article author query
alpert te   [Google Scholar] 
haffty bg   [Google Scholar] 
 

Abstract

For the majority of women with early-stage breast cancer, conservative management with breast conserving surgery plus radiotherapy is widely embraced. However, in patients with germline mutations of BRCA1 and BRCA2, the safety of breast conservation therapy remains controversial. These breast cancer susceptibility genes are associated with an increased risk of second cancers, although the prognosis of BRCA1 or BRCA2 breast cancer is similar to patients with sporadic breast cancer. Preclinical evidence for radiosensitivity has prompted concern for radiation-induced complications in patients with genetic breast cancer. There is limited literature on the safety breast conservation therapy in patients with BRCA1 and BRCA2 mutations. The largest published study reported acute and chronic radiation toxicity results and noted no adverse sequelae in the genetic cohort [1]. Selected published studies demonstrate recurrence rates and overall survival comparable to sporadic controls [1–3]. A series with longer follow-up reported an increase in late second-primary breast cancers, highlighting the need for preventative strategies [4]. Tamoxifen and oophorectomy have a potential role in modifying the rate of second events, and thereby improving the safety of breast conservation therapy.

(Received August 2 2004)
(Accepted August 13 2004)
(BCO Pub date September 9 2004)


Key Words: BRCA1; BRCA2; Conservation surgery; Prophylaxis.

Correspondence:
c1 Correspondence to: Bruce G. Haffty, MD, Department of Therapeutic Radiology, Yale University School of Medicine, P.O. Box 208040, New Haven, CT 06520-8040, USA. Email: bruce.haffty@yale.edu; Tel: +1 203 785 2959; Fax: +1 203 785 4622