title: Should all BRCA1 mutation carriers with stage I breast cancer receive chemotherapy?
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.
authors: Women's College Research Institute, 790 Bay Street, Room 750, Toronto M5G 1N8, Canada. steven.narod@wchospital.ca
authors: Steven A
authors: SA
authors: Narod
authors: Kelly
authors: K
authors: Metcalfe
authors: Henry T
authors: HT
authors: Lynch
authors: Parviz
authors: P
authors: Ghadirian
authors: Andre
authors: A
authors: Robidoux
authors: Nadine
authors: N
authors: Tung
authors: Elizabeth
authors: E
authors: Gaughan
authors: Charmaine
authors: C
authors: Kim-Sing
authors: Olufunmilayo I
authors: OI
authors: Olopade
authors: William D
authors: WD
authors: Foulkes
authors: Mark
authors: M
authors: Robson
authors: Kenneth
authors: K
authors: Offit
authors: Ania
authors: A
authors: Jakubowska
authors: Tomasz
authors: T
authors: Byrski
authors: Tomasz
authors: T
authors: Huzarski
authors: Ping
authors: P
authors: Sun
authors: Jan
authors: J
authors: Lubinski
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D005260:Female; D019398:Genes, BRCA1; D006579:Heterozygote; D006801:Humans; D008875:Middle Aged; D009154:Mutation; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D055815:Young Adult