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

Background: The aim of the study was to calculate the rate of chemotherapy-induced amenorrhea (CIA) after treatment with different adjuvant therapies in patients with breast cancer and to evaluate the risk factors for CIA based on the quality of evidence. Patient and methods: A search of PubMed and ISI Web of Science was performed. All published trials with female breast cancer patients who received adjuvant chemotherapy and presented data on the rate of CIA were considered eligible. The pooled rates of CIA were calculated by random effects model. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each potential risk factor for CIA by using the generic inverse weighted method. Results: We identified 580 potentially relevant studies, of which 75 were included in the analysis. Among 75 eligible studies, 19 different definitions of CIA have been used. The pooled rate of CIA was 55% (95% CI 50-60%) including 23 673 patients from 74 studies. The rate of CIA was increased by age with an estimate of 26% (95% CI 12-43%), 39% (95% CI 31-58%), and 77% (95% CI 71-83%) for women <35, 35-40, and >40 years old, respectively. Two risk factors were associated with the occurrence of CIA and were supported by strong level of evidence: older age (>40 years old), and the use of tamoxifen. Conclusions: This meta-analysis summarized the updated evidence on the impact of different adjuvant treatment regimens for breast cancer in menstruation and could serve as a helpful guide for oncologists during the discussion with their patients on fertility issues before decision on adjuvant therapy is made. A uniform definition of CIA is essential in future studies to make the interpretation of results more reliable.

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“…Similar adaptations have been previously used in the meta-analysis of risk factors in breast cancer [16].…”

Section: Quality Assessmentmentioning

confidence: 98%

Risk of chemotherapy-induced amenorrhea in patients with breast cancer: a systematic review and meta-analysis

Zavos

Valachis

2016

Acta Oncologica

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“…On the other hand, another study reported higher mortality rates in mutation carriers at 116 months of follow-up (15,16).…”

Section: Right Lumpectomy + Slnbmentioning

confidence: 94%

“…In 10 of these, local recurrence rates following breast conserving surgery (BCS) in patients with and without the mutation were evaluated (15). The local recurrence rate was 17% in BRCA mutation carriers, while this rate was 11% in patients without BRCA mutation and this difference was not statistically significant (p=0.07).…”

Section: Right Lumpectomy + Slnbmentioning

confidence: 99%

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Surgical Treatment of Breast Cancer in BRCA-Mutation Carriers

Özmen

2015

J Breasth Health

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Approximately 20 years after identification of mutations in genes associated with breast cancer (BRCA-1,2), the number of women having BRCA-1,2 tests doubled after the famous artist Angelina Jolie who was a BRCA-1 carrier underwent bilateral prophylactic mastectomy (1). The number of women having prophylactic bilateral mastectomy based on a positive test is also increasing. These results emphasize the role of a well-known person in creating awareness.Breast-conserving surgery has been a standard in breast cancer surgery for nearly thirty years, and currently lack of ink staining on the specimen is considered as a negative surgical margin. However, the surgical treatment of women diagnosed with breast cancer and carry BRCA-1,2 is not yet standard. In this group of patients, the treatment of choice is bilateral subcutaneous mastectomy and salpingooophorectomy over the age of 40 years, while at a younger age, in patients who desire to give birth and breastfeed; the decision to choose such a treatment is usually difficult.Currently, it is accepted that the diagnosis and treatment of breast cancer should be individualized, and planning should be made according to the patient's and the tumor's clinical and genetic characteristics. Similarly, the decision for surgical treatment should be based on patient' age and tumor characteristics in BRCA 1,2 carriers. This article focuses on an actual young, nulliparous patient who was diagnosed with breast cancer. Case PresentationOur patient AK is 33 years old, has a mass in the upper outer quadrant of the right breast. She is nulliparous, age at first menstruation is 9 years. On physical examination, both breasts are dense; there is a 15 mm nodular mass on her right breast at 9 o'clock position, with no palpable axillary node. On mammography an asymmetrical density, and on ultrasonography a lobulated, hypovascular mass was observed on her right breast, which was considered as degenerated fibroadenoma (Figure 1, 2). On MRI, the lesion on the upper outer quadrant of the right breast showed cystic degeneration and Type II curve (Figure 3). The tru-cut biopsy was invasive ductal carcinoma, with triplenegative molecular subtype. Pedigree history showed that her mother's grandmother and mother's aunt had breast, her grandmother and mother had ovarian cancer. Her genetic testing for BRCA 1 and 2 mutations was positive. In addition, she had clinical stage I breast cancer. QuestionIf this patient diagnosed with right breast cancer, and she did not have BRCA mutation, which type of surgery would be suggested?1. Lumpectomy + sentinel lymph node biopsy (SLNB) 2. Mastectomy + SLNB 3. Subcutaneous mastectomy + silicone prosthesis reconstruction + SLNB AnswerIn a patient with right-sided breast cancer and no genetic carrier status, the ideal surgical treatment to be offered is lumpectomy-SLNB, if the breast tumor ratio is appropriate. If the patient previously received radiation therapy to the chest wall, or radiation therapy is contraindicated due to collagen disease (lupus erythematosus, de...

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“…Certain genes mutations like BRCA1 and BRCA2 increase the risk of the disease (Valachis, 2014;Smith, 2011). BRCA1 and BRCA2 are human genes that produce tumor suppressor proteins.…”

Section: Introductionmentioning

confidence: 99%

The importance of BRCA1 gene 5382insC mutation detection in an asymptomatic patient: a case report

Serapinas

Lukoševičius

2015

biologija

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We report a case of a patient with the BRCA1 5382insC mutation in the location 17q21. The patient was referred for genetic counseling because of infertility. While consulting the patient for infertility and collecting the family tree, the patient told that her mother, grandmother and aunt had or still have ovarian cancer. So the patient received a genetic test for six most often BRCA1 and BRCA2 gene mutations. The test showed that the patient had the mutation of BRCA1 5382insC gene. The BRCA1 5382insC mutation increases the risk of getting breast cancer 10 times and ovarian cancer 20 times, compared with the general population. To reduce the risk of breast and ovarian cancer the patient received advices on healthy life style, screening tests for ovarian cancer and was offered to consult an oncologist about prophylactic oophorectomy.

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

Cited by 150 publications

References 42 publications

Risk of chemotherapy-induced amenorrhea in patients with breast cancer: a systematic review and meta-analysis

Risk of chemotherapy-induced amenorrhea in patients with breast cancer: a systematic review and meta-analysis

Surgical Treatment of Breast Cancer in BRCA-Mutation Carriers

The importance of BRCA1 gene 5382insC mutation detection in an asymptomatic patient: a case report

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