Is care for BRCA1/2 carriers with early breast cancer guidelines-concordant?

  • Kurian AW & al.
  • JAMA Oncol
  • 6 févr. 2020

  • Par Miriam Davis, PhD
  • Résumés d'articles
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Takeaway

  • Some patients with mutated BRCA1/2 genes may be undertreated with radiotherapy and overtreated with chemotherapy for early breast cancer.

Why this matters

  • Patients carrying mutated genes may not be receiving guidelines-concordant care.

Study design

  • A retrospective population-based cohort of 20,568 women with stages 0-III early breast cancer in the Georgia and California Surveillance, Epidemiology and End Results (SEER) database (2014-2016).
  • Funding: NIH; others.

Key results

  • BRCA1/2-positive patients were less likely than noncarriers to receive radiotherapy postlumpectomy (50.2% vs 81.5%; OR, 0.22; 95% CI, 0.15-0.32), which is nonconcordant with guidelines.
  • BRCA1/2-positive patients with estrogen receptor (ER)-positive disease were more likely than noncarriers to receive chemotherapy (38.0% vs 30.3%; OR, 1.76; 95% CI, 1.31-2.34), which is nonconcordant with guidelines (which only call for endocrine therapy).
  • BRCA1/2 carriers were more likely to receive bilateral mastectomy for unilateral tumors (61.7% vs 24.3%; OR, 5.52; 95% CI, 4.73-6.44), which was in accordance with guidelines.
  • A similar pattern of results was seen for carriers of mutated genes other than BRCA1/2.

Limitations

  • Retrospective, observational design.
  • Genetic test results may have been received after clinical decision-making.