For Lani or anyone else with info please

[Liz J.]

Hi all Her2 family,

I am still contemplating the prophylactic mast on the remaining breast. I had the genetic test last week. I spoke with my Onc. today and the results are that it is not the inherited type, but that I have a non-specific mutation on the BRCA 1. Reports will be sent to my surgeon. Does anyone have any idea about this? If so, I would appreciate input.

Thank you.

Liz J.

[Lani]

readings it would seem that any BRCA1 mutation carries with it problems with DNA repair which would make it more likely that you may develop another breast cancer in the same or the other breast. How much more likely and over what time, I don't know, but if there is a genetic counselling center at a medical school or cancer center near you, they could probably come up with some figures for inherited BRCA1 mutations at least.(won't necessarily hold for you, of course but closer to your situation than data for those without mutations)

The good news--it seems the North American and HERA herceptin adjuvant herceptin trials did not see an increase in recurrence in those treated by mastectomy vs lumpectomy as long as patients were treated according to the protocol ie, chemo and herceptin post-operatively.


Theoretically a larger surgery could stir up more angiogenic factors, but according to the adjuvant studies referred to above it doesn't clearly seem to be the case.

Don't believe there are any similar study results in those treated neoadjuvantly ie comparing large numbers of those treated with mastectomy vs lumpectomy but otherwise the same treatments with/without herceptin

Since your public profile includes no info on your previous treatment (whether your surgery,radiation therapy were long past, whether you had IDC vs inflammatory bc,etc) you may be in a different situation. If there any genetic counselors nearby--they are so used to advising those with inherited BRCA1 mutations they could probably give you some facts, figures on results with different surgical treatment options

Should I come across some papers which shed light on your dilemma, I will post them

Hope some of this helps

[Lani]

I found the following and several others by going to PubMed (google entrez
pubmed) and putting in BRCA1 mastectomy

J Cancer Res Clin Oncol. 2008 Apr 8 [Epub ahead of print] Links

Prevalence of pre-malignant and malignant lesions in prophylactic mastectomy specimens of BRCA1 mutation carriers: comparison with a control group.

Kroiss R, Winkler V, Kalteis K, Bikas D, Rudas M, Tea M, Fuerhauser C, Muhr D, Cerny H, Glueck S, Petru E, Concin H, Kubista E, Oefner P, Wagner T; and the Austrian Hereditary Breast and Ovarian Cancer Group.
Department of Obstetrics and Gynecology, Division of Senology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria, regina.kroiss@meduniwien.ac.at.
PURPOSE: BRCA1 mutation carriers are at high risk for breast cancer (BC). The risk management strategy may include radiological investigations for early detection or prophylactic mastectomy (PM). For a mutation carrier, PM may be more significant than surveillance alone when pre-malignant and malignant changes occur increasingly in mastectomy specimens, given normal findings on radiological investigations. In the present study we retrospectively investigated the differences between histological findings in PM specimens of BRCA1 carriers and those of a control group. METHODS: Twenty-four healthy and 28 affected carriers in the presence of normal preoperative radiological findings were included in the study. To compare the frequency of pre-malignant and malignant lesions in PM specimens, a control group matched for age and disease status was included. T-tests for independent samples and Wilcoxon's signed-rank test were used for comparison of groups. RESULTS: The entire study group differed significantly from the control group (42.3 vs. 5.8%; P < 0.001) in terms of the occurrence of pre-malignant and malignant lesions. Both, the sub-group comparison of healthy mutation carriers as well as diseased carriers with their controls, showed a significant difference in terms of the occurrence of pre-malignant and malignant changes (45.8 vs. 0%; P = 0.002; 39.3 vs. 10.7%; P = 0.03). In PM specimens of mutation carriers, carcinomas were identified in 5.8% (3/52) and pre-malignant changes in 36.5% (19/52). CONCLUSIONS: BRCA1 mutation carriers should be informed of the fact that pre-malignant and even malignant changes are frequently found in PM specimens despite normal radiological findings.

[Liz J.]

Hi Lani,

Thank you for all of your research. Atleast I now have a clue as to what this means with some stats included. I know you must have spent lots of time on this and it is much appreciated. It gives me knowledge that is much needed.

Sincerely,

Liz J.