Dr. Weeks’ Comment: A few years ago, when a famous actress was told she was a carrier for BRCA gene mutation, she decided – very publically – to have her estrogen receptive organs cut out. Many impressionable young women followed her example. At the same time, many doctors were very concerned about the unreasonableness of these decisions. Now the very prestigious medical journal The Lancet has clarified the relative insignificance of being a BRCA carrier and hopefully women will stop being so concerned.
Further more, while I have your attention, let me remind you of the heretical scientific opinion of my friend Prof. Tom Seyfried who have clearly articulated the practically incontestable opinion that oncogenes in general are not the cause of cancer but the consequence of disrupted metabolism in the cytoplasm of the cell – the mitochondria in particular. His excellent article is well worth reading and please share it with your congressman who is voting to fund research on oncogenes – which we now know to be barking up the wrong tree.
Germline BRCA mutation and outcome in young-onset breast cancer (POSH): a prospective cohort study. The Lancet – see this LINK for entire article
Analysis:
Our analysis of the 558 patients with triple-negative breast cancer in our cohort showed an intriguing difference in overall survival over the first few years after diagnosis. BRCA mutation carriers were less likely to die from early breast cancer than non-carriers. This early survival advantage has also been observed among patients with ovarian cancer who are BRCA mutation carriers.29, 30 If real, this advantage might reflect greater sensitivity of BRCA-mutant breast cancers to chemotherapy or the greater visibility of BRCA-mutant cancers to host immune attack.31 One theory that could explain the slight survival advantage for BRCA mutation carriers not undergoing immediate bilateral mastectomy is that a major surgical intervention might compromise host immunity at a time when this is particularly important for eradicating micrometastases. This hypothesis would need further exploration due to the small number of patients in this subgroup.
Summary:
This study confirmed that patients diagnosed with invasive breast cancer aged 18–40 years have a high breast-cancer-specific mortality, and a high proportion are BRCA1 and BRCA2 mutation carriers. We found no clear evidence that either BRCA1 or BRCA2 germline mutations significantly affect overall survival with breast cancer after adjusting for known prognostic factors. Decisions about timing of risk-reducing surgery should take into account primary tumour prognosis and patient preference. BRCA mutation carriers presenting with triple-negative breast cancer might have an improved survival during the first few years after diagnosis compared with non-carriers, although immediate bilateral mastectomy did not account for this advantage. Finally, analysis of early outcome data from trials exploring BRCA-deficient tumour treatment in patients with triple-negative breast cancer should be interpreted with caution in view of the possible early survival advantage for BRCA mutation carriers.