BRCA gene does not affect breast cancer survival and there is no benefit to mastectomy

Advice that has become routine at many cancer centers may have led women to have both of their breasts removed unnecessarily.

This study included 2733 women from the U.K. who were 40 or younger when they were first diagnosed with invasive breast cancer. Although only 5% of breast cancers are diagnosed in women under 40, a large percentage of deaths from breast cancer occur in this group. The researchers wanted to see if women with BRCA1 or BRCA2 gene mutations actually had worse overall survival than women who didn’t, as is commonly believed. This study is the largest of its type to ask this question.

12% of the women had a BRCA mutation. But that didn’t make any difference for survival. At no time over the ten year follow up was there a significant difference in overall survival between the women with and the women without BRCA mutations. After two years, overall survival was 97% for women with BRCA versus 96.6% for women without; at five years, it was 83.8% versus 85%; and at ten years, overall survival was 73.4% for women with BRCA compared to 70.1% for women without. In one type of cancer—triple-negative breast cancer, women with BRCA mutations actually had significantly better overall survival at two years; though the benefit was no longer significant at five or ten years.

There was not only no difference for survival, but there was also no significant difference when comparing “distant disease-free survival.”

Shockingly, though “in many cancer centers” double mastectomy “has become an almost routine recommendation for BRCA1 an BRCA2 mutation carriers”, this study found that immediate removal of both breasts “was not associated with improved survival.”

This landmark study shows that, contrary to common oncological belief, testing for BRCA gene mutations has no beneficial predictive value. Women with these gene mutations have the same survival time and the same disease-free survival time as women without them. Most shockingly, this study also shows that the almost routine “management” strategy of having both breasts removed has caused many women to have unnecessary mastectomies.

Lancet Oncology 2018;

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