Outcomes of breast cancer patients with and without BRCA1/2 mutations (original) (raw)
2007, International Journal of Cancer
We would like to comment on the Moller's et al.'s 1 very interesting report in the Journal for three reasons: (a) the findings of this study are conflicting with another study published most recently in the NEJM 2 that has been criticized for possible biases and errors 3 ; (b) Which results are logically expected and most convincing to the clinic? Here it is to be considered that the management of women with family history for which no data from randomized trials exist is a very controversial topic; (c) To provide an analysis of recent data available on the efficacy and safety of surgical and nonsurgical preventive interventions for women with BRCA1/2 mutations. Among 442 patients with a breast cancer diagnosis, BRCA1 carriers had a worse prognosis than BRCA2 carriers and non-BRCA carriers. 1 Although very small number of BRCA2 carriers (n 5 35) and BRCA1 mutation carriers (n 5 89) is subject to biases and errors, the result is to be expected given that most BRCA1 tumors are histopathologically triple negative tumors (ER/PR/HER2 negative) or basal-like subtype 5 in microarray analysis with a worse survival than patients with BRCA2 tumors with a luminal-like subtype (ER-positive). The opposite and unexpected result with better survival for breast cancer patients with BRCA1 than those with BRCA2 mutation is difficult to be explained. 3 However, it is hard to explain the worse 5-year survival rate (67%) for carcinoma in situ than for node-negative invasive cancers (84%) among BRCA1 mutation carriers.
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