Breast-Conserving Therapy in Women with BRCA1/BRCA2-Associated Breast Cancer

In this article, the controversial issue of breast-conserving therapy (i.e., lumpectomy followed by whole breast irradiation) is reviewed. Given the relatively recent identification of the BRCA1 and BRCA2 genes in the mid-1990s, the expense associated with testing, and the inherent selection biases, the available literature has inherent limitations with relatively small patient numbers and lack of prospective randomized trials in this subset of patients. However, a number of retrospective and case-control studies have demonstrated acceptable results with breast-conserving surgery and radiation, although without active prophylactic measures to reduce secondary malignancies, late local in-breast relapses and contralateral secondary breast cancer events remain an issue. Acknowledging the limitations in the available data, there does not appear to be any evidence of compromised normal tissue reactions or compromised long-term survival rates in women electing breast-conserving surgery and radiation.