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

Steven A. Narod, 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

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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.

Original languageEnglish
Pages (from-to)273-279
Number of pages7
JournalBreast Cancer Research and Treatment
Volume138
Issue number1
DOIs
StatePublished - 2013

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Breast Neoplasms
Drug Therapy
Mutation
Survival
Survival Rate
Neoplasms
Estrogen Receptors
Mortality

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Should all BRCA1 mutation carriers with stage i breast cancer receive chemotherapy? / Narod, Steven A.; Metcalfe, Kelly; Lynch, Henry T.; Ghadirian, Parviz; Robidoux, Andre; Tung, Nadine; Gaughan, Elizabeth; Kim-Sing, Charmaine; Olopade, Olufunmilayo I.; Foulkes, William D.; Robson, Mark; Offit, Kenneth; Jakubowska, Ania; Byrski, Tomasz; Huzarski, Tomasz; Sun, Ping; Lubinski, Jan.

In: Breast Cancer Research and Treatment, Vol. 138, No. 1, 2013, p. 273-279.

Research output: Contribution to journalArticle

Narod, SA, Metcalfe, K, Lynch, HT, Ghadirian, P, Robidoux, A, Tung, N, Gaughan, E, Kim-Sing, C, Olopade, OI, Foulkes, WD, Robson, M, Offit, K, Jakubowska, A, Byrski, T, Huzarski, T, Sun, P & Lubinski, J 2013, 'Should all BRCA1 mutation carriers with stage i breast cancer receive chemotherapy?', Breast Cancer Research and Treatment, vol. 138, no. 1, pp. 273-279. https://doi.org/10.1007/s10549-013-2429-x
Narod, Steven A. ; Metcalfe, Kelly ; Lynch, Henry T. ; Ghadirian, Parviz ; Robidoux, Andre ; Tung, Nadine ; Gaughan, Elizabeth ; Kim-Sing, Charmaine ; Olopade, Olufunmilayo I. ; Foulkes, William D. ; Robson, Mark ; Offit, Kenneth ; Jakubowska, Ania ; Byrski, Tomasz ; Huzarski, Tomasz ; Sun, Ping ; Lubinski, Jan. / Should all BRCA1 mutation carriers with stage i breast cancer receive chemotherapy?. In: Breast Cancer Research and Treatment. 2013 ; Vol. 138, No. 1. pp. 273-279.
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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.",
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AU - Narod, Steven A.

AU - Metcalfe, Kelly

AU - Lynch, Henry T.

AU - Ghadirian, Parviz

AU - Robidoux, Andre

AU - Tung, Nadine

AU - Gaughan, Elizabeth

AU - Kim-Sing, Charmaine

AU - Olopade, Olufunmilayo I.

AU - Foulkes, William D.

AU - Robson, Mark

AU - Offit, Kenneth

AU - Jakubowska, Ania

AU - Byrski, Tomasz

AU - Huzarski, Tomasz

AU - Sun, Ping

AU - Lubinski, Jan

PY - 2013

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N2 - 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.

AB - 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.

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