Breast Cancer and Pregnancy in Young BRCA Carriers

To the Editor In the article by Dr Lambertini and colleagues on pregnancy after breast cancer in young BRCA carriers, the authors compared the outcomes of patients with breast cancer and BRCA1 or BRCA2 variants according to whether or not they had a pregnancy after having breast cancer. They found no effect of pregnancy on the outcome of disease-free survival (local recurrence, contralateral breast cancer, distant recurrence) (hazard ratio, 0.99; 95% CI, 0.81-1.20) but found a significant improvement in breast cancer –specific survival (death due to breast cancer) with pregnancy (hazard ratio, 0.53; 95% CI, 0.37-0.74; P <  .001). The difference in the results for the different outcomes is not easily explained. There were excesses in distant recurrences and second primary malignancies (non–breast cancer) in the nonpregnancy group (eTable 1 in Supplement 2 of the article). There was also an excess of contralateral cancers in the pregnancy group. Patients with oophorectomy were not excluded from the analysis. In our previous studies, we have seen a benefit of oophorectomy on breast cancer survival in BRCA carriers. However, Lambertini and colleagues did not report the effect of oophorectomy. The clinical relev ance of the effect of oophorectomy is pertinent to young BRCA carriers recently diagnosed with breast cancer who may be choosing between pregnancy and salpingo-oophorectomy.
Source: JAMA - Category: General Medicine Source Type: research