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Surgical management of breast cancer in BRCA-mutation carriers: a systematic review and meta-analysis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
2014 (English)In: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 144, no 3, 443-455 p.Article, review/survey (Refereed) Published
Abstract [en]

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 a parts per thousand yen7 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.

Place, publisher, year, edition, pages
2014. Vol. 144, no 3, 443-455 p.
Keyword [en]
BRCA, Breast cancer, Breast-conserving therapy, Meta-analysis
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-224169DOI: 10.1007/s10549-014-2890-1ISI: 000333360700001OAI: oai:DiVA.org:uu-224169DiVA: diva2:716941
Available from: 2014-05-13 Created: 2014-05-05 Last updated: 2014-05-13Bibliographically approved

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Valachis, Antonis
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Centre for Clinical Research, County of Västmanland
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