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Conference Paper: Comparing survival outcomes between breast-conserving surgery and mastectomy among BRCA carriers and non-carriers

TitleComparing survival outcomes between breast-conserving surgery and mastectomy among BRCA carriers and non-carriers
Authors
Issue Date2020
PublisherSpringer for American Society of Breast Surgeons and Society of Surgical Oncology. The Journal's web site is located at http://www.annalssurgicaloncology.org
Citation
The 21st Annual Meeting of The American Society of Breast Surgeons, Las Vegas, USA, 29 April - 3 May 2020. Proceedings in Annals of Surgical Oncology, 2020, v. 27 n. Suppl. 2, p. S370-S371, abstract no. 780710 How to Cite?
AbstractBackground/Objective: Breast cancer is the most common cancer and third leading cause of cancer deaths among females in Hong Kong. Hereditary cancers account for 5-10% of breast cancers, of which, 80% of hereditary breast cancer is due to BRCA1 and BRCA 2 mutations. The aims of management of breast cancer in BRCA mutation carriers are threefold - curative, risk reduction, and good cosmesis. Currently, controversy exists between breast-conserving surgery (BCS) and mastectomy for BRCA mutation carriers with some studies suggesting a higher ipsilateral breast cancer recurrence rate for BCS. Survival data is limited. This study aims to evaluate the survival outcomes between BCS and mastectomy among BRCA and non-BRCA mutation carriers in breast cancer patients. Methods: This is a retrospective study analyzing prospectively maintained data for BRCA carriers and non-carriers diagnosed with breast cancer who underwent genetic testing between January 1st, 2007 to December 31st, 2018 and received either a breast-conserving surgery (BCS) or mastectomy. Patients who were tested positive for BRCA 1 or 2 were included; those that were tested positive for other pathogenic mutations such as PTEN, TP53 were excluded. Stage IV disease and bilateral breast cancer patients were also excluded. Local recurrence, overall survival, cancer-specific survival, and disease-free survival were analyzed by Log-rank test. Subgroup analyses of survival between different disease stages, BRCA status, surgical option and triple-negative tumors were conducted by Log-rank test with p-values adjusted by Benjamini and Hochberg (BH) method. A Cox proportional hazards model was used to investigate the associated risk factors. Results: A total of 3080 patients were included in the analysis, with 142 BRCA mutation carriers and 2938 non-carriers. The BCS and mastectomy rates in the BRCA mutation group were 42.3% and 57.7% respectively compared to 33.8% and 66.2% in the non-carrier group (p=0.048). There was no statistical significance between the different surgical groups and BRCA carrier status regarding local recurrence rate. Log-rank test showed that a poorer disease staging showed significantly worse overall survival, cancer-specific survival, and disease-free survival (p<0.0001). In a subgroup analysis, BRCA mutation carriers with Stage I disease who received BCS or mastectomy had a worse overall survival compared to non-carrier groups (p=0.0097). This finding was similar for cancer specific survival (p=0.0031). There was no difference in survival for other disease stages, disease-free survival, or triple-negative breast cancer patients. A Cox proportional hazards model revealed that BRCA mutation status (p=0.71) and type of surgery (p=0.30) were not independent risk factors for poorer survival. Conclusions: BCS is not associated with adverse long-term survival outcomes in BRCA mutation carriers and has no survival benefits over mastectomy. The consideration for BCS should be based on surgical eligibility irrespective of genetic status. With appropriate preoperative counseling, BCS should be offered as an option to BRCA mutation carriers.
DescriptionVirtual Scientific Session - Poster Presentation - Abstract no. 780710
Persistent Identifierhttp://hdl.handle.net/10722/284639
ISSN
2023 Impact Factor: 3.4
2023 SCImago Journal Rankings: 1.037

 

DC FieldValueLanguage
dc.contributor.authorMak, CK-
dc.contributor.authorLuk, WP-
dc.contributor.authorFung, LH-
dc.contributor.authorKwong, A-
dc.date.accessioned2020-08-07T09:00:33Z-
dc.date.available2020-08-07T09:00:33Z-
dc.date.issued2020-
dc.identifier.citationThe 21st Annual Meeting of The American Society of Breast Surgeons, Las Vegas, USA, 29 April - 3 May 2020. Proceedings in Annals of Surgical Oncology, 2020, v. 27 n. Suppl. 2, p. S370-S371, abstract no. 780710-
dc.identifier.issn1068-9265-
dc.identifier.urihttp://hdl.handle.net/10722/284639-
dc.descriptionVirtual Scientific Session - Poster Presentation - Abstract no. 780710-
dc.description.abstractBackground/Objective: Breast cancer is the most common cancer and third leading cause of cancer deaths among females in Hong Kong. Hereditary cancers account for 5-10% of breast cancers, of which, 80% of hereditary breast cancer is due to BRCA1 and BRCA 2 mutations. The aims of management of breast cancer in BRCA mutation carriers are threefold - curative, risk reduction, and good cosmesis. Currently, controversy exists between breast-conserving surgery (BCS) and mastectomy for BRCA mutation carriers with some studies suggesting a higher ipsilateral breast cancer recurrence rate for BCS. Survival data is limited. This study aims to evaluate the survival outcomes between BCS and mastectomy among BRCA and non-BRCA mutation carriers in breast cancer patients. Methods: This is a retrospective study analyzing prospectively maintained data for BRCA carriers and non-carriers diagnosed with breast cancer who underwent genetic testing between January 1st, 2007 to December 31st, 2018 and received either a breast-conserving surgery (BCS) or mastectomy. Patients who were tested positive for BRCA 1 or 2 were included; those that were tested positive for other pathogenic mutations such as PTEN, TP53 were excluded. Stage IV disease and bilateral breast cancer patients were also excluded. Local recurrence, overall survival, cancer-specific survival, and disease-free survival were analyzed by Log-rank test. Subgroup analyses of survival between different disease stages, BRCA status, surgical option and triple-negative tumors were conducted by Log-rank test with p-values adjusted by Benjamini and Hochberg (BH) method. A Cox proportional hazards model was used to investigate the associated risk factors. Results: A total of 3080 patients were included in the analysis, with 142 BRCA mutation carriers and 2938 non-carriers. The BCS and mastectomy rates in the BRCA mutation group were 42.3% and 57.7% respectively compared to 33.8% and 66.2% in the non-carrier group (p=0.048). There was no statistical significance between the different surgical groups and BRCA carrier status regarding local recurrence rate. Log-rank test showed that a poorer disease staging showed significantly worse overall survival, cancer-specific survival, and disease-free survival (p<0.0001). In a subgroup analysis, BRCA mutation carriers with Stage I disease who received BCS or mastectomy had a worse overall survival compared to non-carrier groups (p=0.0097). This finding was similar for cancer specific survival (p=0.0031). There was no difference in survival for other disease stages, disease-free survival, or triple-negative breast cancer patients. A Cox proportional hazards model revealed that BRCA mutation status (p=0.71) and type of surgery (p=0.30) were not independent risk factors for poorer survival. Conclusions: BCS is not associated with adverse long-term survival outcomes in BRCA mutation carriers and has no survival benefits over mastectomy. The consideration for BCS should be based on surgical eligibility irrespective of genetic status. With appropriate preoperative counseling, BCS should be offered as an option to BRCA mutation carriers.-
dc.languageeng-
dc.publisherSpringer for American Society of Breast Surgeons and Society of Surgical Oncology. The Journal's web site is located at http://www.annalssurgicaloncology.org-
dc.relation.ispartofAnnals of Surgical Oncology-
dc.relation.ispartof21st Annual Meeting of The American Society of Breast Surgeons, 2020-
dc.titleComparing survival outcomes between breast-conserving surgery and mastectomy among BRCA carriers and non-carriers-
dc.typeConference_Paper-
dc.identifier.emailKwong, A: avakwong@hku.hk-
dc.identifier.authorityKwong, A=rp01734-
dc.identifier.hkuros311635-
dc.identifier.volume27-
dc.identifier.issueSuppl. 2-
dc.identifier.spageS370-
dc.identifier.epageS371-
dc.publisher.placeUnited States-
dc.identifier.partofdoi10.1245/s10434-020-08630-3-
dc.identifier.issnl1068-9265-

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