Breast Cancer Gene: Can the Breast Be Saved?

In women with the breast cancer gene BRCA, breast-conserving therapy may be a “reasonable option,” researchers say.

But women should discuss the option of undergoing bilateral mastectomy, removal of both breasts, their report shows.

Once a woman with the BRCA gene has breast cancer, there’s a 3 to 5 percent risk per year of developing cancer in the other breast. Therefore, both breasts are frequently removed in women with these inherited mutations.

But some studies have shown the breast-conserving therapy of lumpectomy (removal of the cancer and some of the surrounding breast tissue), followed by radiation, may be a reasonable option for some of these women.

The new study, which appears in the Jan. 1, 2005 issue of the journal Cancer, was conducted by researchers including Mark Robson, MD, of Memorial Sloan-Kettering Cancer Center in New York City.

Robson and colleagues studied 87 women who had BRCA mutations. The average age of the women was 43. Each woman underwent lumpectomy with radiation.

The study showed mixed results.

On the one hand, the women had no increased risk of getting breast cancer again in the same breast, compared with breast cancer patients without the gene mutations.

However, the women did have an increased risk of getting breast cancer in the other breast. Over 10 years, about 37 percent had breast cancer diagnosed in their second breast.

The researchers point out that the long-term outlook may also not be as promising in the women that chose breast-conserving therapy. More research is needed to follow this group of women for longer periods of time.

Taking all this into consideration, Robson and colleagues say women with the BRCA gene and breast cancer can still consider breast-conserving therapy a “reasonable option,” but they should also discuss bilateral mastectomy.

Genes and Breast Cancer

Most women with breast cancer do not have the BRCA gene mutations, which were identified nearly a decade ago.

For women with a strong family history of breast cancer — multiple close family members, such as mothers, sisters, and aunts — genetic screening can be considered. However, it’s a personal choice that often involves balancing a desire for information with the understandable stresses and emotions of probing genetic inclination to the disease.

The gene mutations don’t automatically condemn women to breast cancer.

It’s estimated that women with a BRCA gene mutation have a 36-85 percent risk of developing breast cancer at some point in their lives, as well as a 16-60 percent lifetime risk of developing ovarian cancer.

By Miranda Hitti, reviewed by Brunilda Nazario, MD

SOURCES: Robson, M. Cancer, Jan. 1, 2005. News release, John Wiley & Sons, Inc. WebMD Medical Reference from Healthwise: “Breast Cancer (BRCA) Gene Testing.”