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Breast Cancer Research and Treatment

, Volume 138, Issue 1, pp 273–279 | Cite as

Should all BRCA1 mutation carriers with stage I breast cancer receive chemotherapy?

  • Steven A. NarodEmail author
  • Kelly Metcalfe
  • Henry T. Lynch
  • Parviz Ghadirian
  • Andre Robidoux
  • Nadine Tung
  • Elizabeth Gaughan
  • Charmaine Kim-Sing
  • Olufunmilayo I. Olopade
  • William D. Foulkes
  • Mark Robson
  • Kenneth Offit
  • Ania Jakubowska
  • Tomasz Byrski
  • Tomasz Huzarski
  • Ping Sun
  • Jan Lubinski
Epidemiology

Abstract

To estimate the 15-year survival following a diagnosis of stage I breast cancer among women who carry a BRCA1 mutation and to determine predictors of mortality, including the use of chemotherapy. Patients were 379 women with stage I breast cancer for whom a BRCA1 mutation had been identified, in herself or in a close family member. Patients were followed for up to 15 years from the initial diagnosis of breast cancer. Survival rates were estimated for women by age, tumor size (≤1 cm; >1 cm), ER status (±), and by chemotherapy (yes/no). 42 women died of breast cancer in the follow-up period (11.2 %). Survival rates were similar for women with cancers of size 0–1.0 cm and size 1.1–2.0 cm. Of the 267 women in the study who used chemotherapy, 21 had died (7.9 %) compared to 21 deaths among 112 women who did not receive chemotherapy (18.8 %; p = 0.002). The 15-year survival was 89.4 % for women who received chemotherapy and was 73.1 % for women who did not receive chemotherapy (p = 0.08; log rank). The adjusted hazard ratio for death following a diagnosis of stage I breast cancer associated with chemotherapy was 0.53 (95 % CI 0.28–1.07; p value 0.06) after adjusting for age of diagnosis, tumor size, and estrogen receptor status. This was statistically significant only among women with ER-negative breast cancers (HR = 0.28; 95 % CI 0.10–0.79; p = 0.02). BRCA1 positive women who are treated for stage I breast cancer with chemotherapy have better survival than those who do not receive chemotherapy. The difference cannot be explained by other prognostic factors. All women with invasive breast cancer and a BRCA1 mutation should be considered to be candidates for chemotherapy.

Keywords

BRCA1 Stage I Breast cancer Survival 

Notes

Acknowledgments

We thank Fonds de la recherche en santé du Québec (FRSQ), the Canadian Breast Cancer Research Alliance and the Canadian Breast Cancer Foundation (Ontario Chapter) for their support. Also supported by the Polish Ministries of Science and Health.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

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Supplementary material 1 (TIFF 1492 kb)
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Supplementary material 2 (TIFF 1492 kb)

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Steven A. Narod
    • 1
    Email author
  • Kelly Metcalfe
    • 1
    • 2
  • Henry T. Lynch
    • 3
  • Parviz Ghadirian
    • 4
  • Andre Robidoux
    • 4
  • Nadine Tung
    • 5
  • Elizabeth Gaughan
    • 5
  • Charmaine Kim-Sing
    • 6
  • Olufunmilayo I. Olopade
    • 7
  • William D. Foulkes
    • 8
  • Mark Robson
    • 9
  • Kenneth Offit
    • 9
  • Ania Jakubowska
    • 10
  • Tomasz Byrski
    • 10
  • Tomasz Huzarski
    • 10
  • Ping Sun
    • 1
  • Jan Lubinski
    • 10
  1. 1.Women’s College Research InstituteTorontoCanada
  2. 2.Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoCanada
  3. 3.Department of Preventive Medicine and Public HealthCreighton University School of MedicineOmahaUSA
  4. 4.Epidemiology Research UnitCentre Hospitalier de Université de Montreal (CHUM)MontrealCanada
  5. 5.Beth Israel Deaconess Medical CenterBostonUSA
  6. 6.BC Cancer AgencyVancouverCanada
  7. 7.Department of MedicineUniversity of ChicagoChicagoUSA
  8. 8.Program in Cancer GeneticsMcGill UniversityMontrealCanada
  9. 9.Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkUSA
  10. 10.Pomeranian Medical UniversitySzczecinPoland

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