Reoccurrence in BRCA1 Patients after Lumpectomy
Dear OncoLink "Ask The Experts,"
My wife was just confirmed to have the BRCA1 Gene. She is 2 weeks post lumpectomy. We start chemotherapy on Tuesday, Sept 10th for 8 weeks. She is 44 years old. The oncologist recommends that she have her ovaries removed, with which we have no problem. However, my wife would like to keep her breasts. I cannot find a good study on the prospects of reoccurrence in BRCA1 patients after they have had a 1st lumpectomy/Chemo/Radiation/Ovary removal while keeping the breast. Could you direct me please to a good study, recommendation? Thank you!
Jill Stopfer, MS, CGC, Certified Genetic Counselor, responds:
The chance of breast cancer recurrence depends on many things, like the tumor size, grade, number of lymph nodes, hormone receptor status, her2/neu status, and of course the treatment regimen selected. It is completely patient dependent, and generally this information should be obtained by the treating oncologist. With regard to the question of what a BRCA 1 patient's chances are for developing a *second* breast cancer, (not just a return of the one already treated), those chances are in the neighborhood of 50%.
It would be a good idea to make sure BRCA 1 patients consult with an expert in cancer genetics. Not all oncologists, even expert oncologists, are experts in BRCA1 and treatment of breast cancer. For patients who are local to the Philadelphia area, I would strongly recommend that she be seen by Susan Domchek, MD. If not, there are other cancer genetics programs like ours around the country. There is evidence, not yet published but known to this group, that oophorectomy lowers risk for breast cancer to a LESSER degree in women with the BRCA1 gene compared to those with BRCA2. But the specific numbers are still being worked out. Look for upcoming publications by Rebbeck, TR et al.
I would also recommend the informational and support organization called FORCE (facing our risk of cancer empowered) www.facingourrisk.org, which largely is designed for those dealing with issues around BRCA1/2 - it's excellent. In addition, the National Cancer Institute has quite a bit of peer reviewed information on their website about BRCA1 and breast cancer. www.cancer.gov