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Clinical Study

Survival from breast cancer in women with a BRCA2 mutation by treatment

Abstract

Background

The impact of various breast-cancer treatments on patients with a BRCA2 mutation has not been studied. We sought to estimate the impact of bilateral oophorectomy and other treatments on breast cancer-specific survival among patients with a germline BRCA2 mutation.

Methods

We identified 664 women with stage I–III breast cancer and a BRCA2 mutation by combining five different datasets (retrospective and prospective). Subjects were followed for 7.2 years from diagnosis to death from breast cancer. Tumour characteristics and cancer treatments were patient-reported and derived from medical records. Predictors of survival were determined using Cox proportional hazard models, adjusted for other treatments and for prognostic features.

Results

The 10-year breast-cancer survival for ER-positive patients was 78.9% and for ER-negative patients was 82.3% (adjusted HR = 1.23 (95% CI, 0.62–2.45, p = 0.55)). The 10-year breast-cancer survival for women who had a bilateral oophorectomy was 89.1% and for women who did not have an oophorectomy was 59.0% (adjusted HR = 0.45; 95% CI, 0.28–0.72, p = 0.001). The adjusted hazard ratio for chemotherapy was 0.83 (95% CI, 0.65–1.53: p = 0.56).

Conclusions

For women with breast cancer and a germline BRCA2 mutation, positive ER status does not predict superior survival. Oophorectomy is associated with a reduced risk of death from breast cancer and should be considered in the treatment plan.

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Fig. 1: Ten-year breast cancer-specific survival for women with BRCA2 mutations.
Fig. 2: Ten-year breast cancer-specific survival for women with BRCA2 mutations.

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Acknowledgements

Our sincere gratitude for the valuable contributions of the women who participated in this study, without whom this research would not be possible. We would like to acknowledge the following individuals for helping with data collection: Sara Lazzarin, Debora Vicini and Federica Sina.

Other members of the Polish Hereditary Breast Cancer Consortium

Błasińska-Morawiec Maria16, Chosia Maria17, Drosik Kazimierz18, Gozdecka-Grodecka Sylwia19, Goźdź Stanisław20, Grzybowska Ewa21, Jeziorski Arkadiusz22, Karczewska Aldona23, Kordek Radzisław22, Synowiec Agnieszka24, Kozak-Klonowska Beata25, Lamperska Katarzyna26, Lange Dariusz27, Mackiewicz Andrzej19, Mituś Jerzy Władysław28, Niepsuj Stanislas29, Oszurek Oleg17, Gugała Karol30, Morawiec Zbigniew16, Mierzwa Tomasz31, Posmyk Michał32, Ryś Janusz33, Szczylik Cezary34, Uciński Michał17, Urbański Krzysztof35, Waśko Bernard36, Wandzel Piotr37

Other members of the kConFab Follow-Up Study Team

Michael Friedlander38, Sue Anne McLachlan39, Stephanie Nesci40, Sandra Picken40, Sarah O’Connor40, Lucy Stanhope40

Other members of Hereditary Breast Cancer Clinical Study Group

Andrea Eisen41, Kevin Sweet42, Raymond Kim43, William Foulkes44, Pal Moller45, Susan Neuhausen46, Carey Cullinane47, Charis Eng48, Peter Ainsworth49, Fergus Couch50, Christian Singer51, Beth Karlan52, Wendy McKinnon53, Marie Wood53

Author information

Affiliations

Authors

Consortia

Contributions

Conception, design and study supervision: S.A.N. Acquisition of data: J.G., J.L., T.H., Z.H., C.F., K.M., L.S., D.Z. and M.E. Analysis of clinical data: R.F., J.L., C.C., D.Z., J.W. and N.T. Statistical analysis and critical review: P.S., R.L.M. and K.M. Interpretation of the results and writing of the original draft: D.G.E., S.A.N. and K.A.P. All authors revised the paper and approved the final version.

Corresponding author

Correspondence to Steven A. Narod.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the following institutional ethics review boards: Women’s College Hospital Ethics Board, Research Ethics Committee of the Pomeranian Medical University, Central Manchester Research Ethics Committee (10/H1008/24 and 11/H1003/3), Peter MacCallum Cancer Centre Human Research Ethics Committee (97/27) and the Ethical Committee Brianza. All study subjects provided written informed consent. The study was performed in accordance with the Declaration of Helsinki.

Consent to publish

Individual person’s data not included.

Data availability

All data relevant to the study are included in the paper.

Competing interests

Steven A. Narod is a board member of BJC. All other authors declare no conflict of interest.

Funding information

This work was supported by grants to kConFab and the kConFab Follow-Up Study from Cancer Australia (809195, 1100868), the Australian National Breast Cancer Foundation (IF 17), the National Health and Medical Research Council (454508, 288704 and 145684), the National Institute of Health USA (1RO1CA159868), the Queensland Cancer Fund, the Cancer Councils of New South Wales, Victoria, Tasmania and South Australia and the Cancer Foundation of Western Australia. K.A.P. is an Australian National Breast Cancer Foundation Fellow (PRAC17-004). The work is supported by the Peter Gilgan Center for Research on Women’s Cancers and the Canadian Institute of Health Research (FDN 154275). D.G.E. is supported by the NIHR Manchester Biomedical Research Centre (IS-BRC-1215-20007).

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Note This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution 4.0 International (CC BY 4.0).

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Members of the Polish Breast Cancer Consortium, kConFab Follow-Up Study Team and Hereditary Breast Cancer Clinical Study Group are listed above Acknowledgements.

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Evans, D.G., Phillips, KA., Milne, R.L. et al. Survival from breast cancer in women with a BRCA2 mutation by treatment. Br J Cancer (2021). https://doi.org/10.1038/s41416-020-01164-1

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