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Surgical management of breast cancer in BRCA-mutation carriers: a systematic review and meta-analysis

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Abstract

This meta-analysis investigates the oncological safety of breast-conserving therapy BCT in BRCA-mutation carriers and the risk for contralateral breast cancer (CBC) compared with non-carriers, potential risk factors for ipsilateral breast recurrence (IBR) or CBC and grades these factors based on the level of evidence. A PubMed search was conducted through April 2013 to identify studies that described the risk for IBR and CBC after BCT in BRCA-mutation carriers versus non-carriers as well as studies that investigated risk factors for IBR and CBC in BRCA-mutation carriers. Results were summarized using meta-analysis when sufficient studies were available. Ten studies investigated the oncological safety of BCT in BRCA-mutation carriers versus non-carriers. There was no significant difference in IBR between carriers and controls (RR 1.45, 95 % CI 0.98–2.14). However, a significant higher risk for IBR in BRCA-mutation carriers was observed in studies with a median follow-up ≥7 years (RR 1.51, 95 % CI 1.15–1.98). CBCs were significantly greater in carriers versus controls (RR 3.56, 95 % CI 2.50–5.08). Use of adjuvant chemotherapy and oophorectomy were associated with a significantly lower risk for IBR in BRCA-mutation carriers. Three factors were associated with a lower risk for CBC in BRCA-mutation carriers: oophorectomy, use of tamoxifen, and age at first breast cancer. Based on current evidence, the use of BCT in BRCA-mutation carriers can be considered a reasonable option since it does not seem to increase the risk for IBR. However, several aspects should be taken into account before the final decision-making.

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Acknowledgments

This study has been funded by the Centre for Clinical Research Sörmland, Uppsala University.

Conflict of interest

The authors have no conflict of interest to declare.

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Authors and Affiliations

  1. Department of Oncology, Mälarsjukhuset, 63188, Eskilstuna, Sweden

    Antonis Valachis, Andreas D. Nearchou & Pehr Lind

  2. Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden

    Antonis Valachis

  3. Karolinska Institute, 11883, Stockholm, Sweden

    Pehr Lind

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  1. Antonis Valachis
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  2. Andreas D. Nearchou
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Correspondence to Antonis Valachis.

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Valachis, A., Nearchou, A.D. & Lind, P. Surgical management of breast cancer in BRCA-mutation carriers: a systematic review and meta-analysis. Breast Cancer Res Treat 144, 443–455 (2014). https://doi.org/10.1007/s10549-014-2890-1

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  • DOI: https://doi.org/10.1007/s10549-014-2890-1

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