Locoregional Treatments and Ipsilateral Breast Cancer Recurrence Rates in BRCA1/2 Mutation Carriers

A Delphi study and International Consensus Recommendations: The use of bolus in the setting of postmastectomy radiation therapy for early breast cancer

“…Importantly, independently of the surgical incision and removal of overlying skin, the skin-flap thickness and related complications are highly dependent on the surgeon ´s expertise [62,63]. Over 90% of all local recurrences after these procedures occur within five years suggesting subclinical residual disease and residual breast glandular tissue [51,64,65].…”

Surgical Management of Inherited Breast Cancer: Role of Breast-Conserving Surgery

“…These authors also showed that BCS was associated with a greater rate of ipsilateral BC recurrence in BRCA mutation carriers, revealing that the pooled ipsilateral BC recurrence rates at 5, 10, and 15 years were higher in the BCS group (8.2%, 15.5%, and 23%, respectively) than in the mastectomy group (3.4%, 4.9%, and 6.4%, respectively) [77]. However, this analysis did not take into consideration recent studies on the same subject [90,92,95], one of which, authored by Huang et al, concluded to the contrary that BCT and mastectomy have similar local recurrence rates [95].…”

“…In BRCA1/2 mutation carriers, the risk of contralateral BC (CBC) was also found to be higher, with a 10-year cumulative incidence of 25% as opposed to the 1% found in sporadic controls (p = 0.03) [88]. Over time, several retrospective studies comparing BCT to mastectomy in high-risk BC patients showed an increased risk of local recurrence [89][90][91][92]. A meta-analysis of ten studies also confirmed a significantly higher risk of IBTR in BRCA1/2 mutation carriers compared to non-carriers following BCS at a median follow-up greater than 7 years, but no difference was found for shorter follow-up periods [93].…”

“…Moreover, a multi-institutional retrospective analysis by Bernstein-Molho and colleagues reported higher rates of new primary BC in BRCA-associated BC patients treated with BCT than in those treated with mastectomy, although there were no differences in regional or distant recurrences or in overall survival, suggesting BCT is an acceptable alternative to mastectomy in the treatment of BRCA1/2-associated BC, despite the higher lifetime risk of developing BC [92].…”

Superficial margins in skin sparing and nipple sparing mastectomies for DCIS: A margin of potential concern

“…The potential of leaving residual breast glandular tissue after SSM/NSM is associated with the thickness of the skin flap and location, with most residual breast tissue found under the nipple and areola complex [9,10]. This was assumed to be the reason for high ipsilateral local recurrences observed in breast cancer BRCA1/2 mutation carriers treated with SSM/NSM without PMRT compared to those with a more advanced breast cancer stage who received PMRT [11]. As local recurrence of invasive breast cancer can result from lymphovascular invasion into the subcutaneous lymphatic plexus, beside from residual glandular tissue or residual disease, it is expected that the rate of DCIS recurrences after margin free SSM/NSM will be lower (~1% recurrence rate of DCIS after mastectomy) as compared to invasive cancer [5,11].…”