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Risks Outlined for Women With Breast Cancer Gene

Recurrence unlikely in affected breast after lumpectomy, study finds

MONDAY, Nov. 22, 2004 (HealthDayNews) -- There is good research news for women with breast cancer who carry a cancer-causing gene and are treated with breast-conserving therapy: the risk that cancer will recur in that breast is no higher than for women who don't carry that gene.

But the good news is balanced by a finding that the risk of cancer in the opposite breast is increased significantly, said a report in an upcoming issue of Cancer by physicians at Memorial Sloan-Kettering Cancer Center in New York City.

It is a study done in the hopes of providing decision-making information for women who carry one of the BRCA cancer genes and must choose between mastectomy, removal of the entire breast, or lumpectomy, removal of just the cancer and surrounding tissue, said study author Dr. Mark Robson, an assistant attending physician at Memorial Sloan-Kettering.

"It has been a controversial issue," Robson said. "Now we can say that at least in the short and intermediate term -- five to 10 years -- there is no greater risk of recurrence in that breast than reported for other women."

The study followed 87 women known to carry a BRCA gene who had lumpectomy for a cancer in one breast. After 10 years, the cancer recurred in 13.6 percent of those women, a rate comparable to that reported for women who do not carry the gene.

More than a third of the women -- 37.6 percent -- in the study had a new cancer in the untreated breast within 10 years of their original diagnosis, the study found. Robson said previous studies have shown a rate of about 8 percent in women without the gene.

The decision about having lumpectomy or total breast removal, and about having the unaffected breast removed because of the high risk of cancer, must be made by the woman, Robson said. The study provides "another data point for women to use," he said.

"Women have to be made aware of their risks and the options for managing those risks," Robson said. "This study can be used to help understand those risks."

Overall, about 5 percent of women with breast cancer are found to have mutated BRCA genes that increase the risk of cancer, he said. The incidence is higher in some ethnic groups, such as Jews of Eastern European origin, Icelanders, the Dutch, and inhabitants of the Balkans, Robson said.

Several studies about the risk of recurrence in those women have been done, Robson said. "The results have been conflicting, but most studies have been converging on the results that we obtained," he added.

The decision on surgery is a highly personal matter, Robson said. "Some women will say, 'The risk is too high, I don't want to take that chance.' Others will say, 'I prefer to preserve my breast.'"

Whatever the choice, these women should be monitored carefully, with a magnetic resonance imaging or ultrasound screening test every year, he said.

More information

An overview of the genetics of breast cancer can be found at the National Cancer Institute.

SOURCES: Mark Robson, M.D., assistant attending physician, Memorial Sloan-Kettering Cancer Center, New York City; Jan. 1, 2005, Cancer
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