Two recent breast cancer studies have received heavy news coverage and we have asked members of our Medical Advisory Board to offer their interpretations of these reports. The first is an October report in the British journal The Lancet which found that radiation in women with lumpectomies (or other breast conserving surgeries) significantly reduced the risk of a recurrence in the first decade after surgery, and also reduced the risk of death from breast cancer for up to 15 years. The report, by Sarah C. Darby, Professor of Medical Statistics at the University of Oxford and others, is based on a meta-analysis of 17 different studies involving over 10,000 women in Europe, Canada and the United States.
 

"This is confirmation of what many physicians have long believed - that radiation makes a big difference. For 30 years, doctors have argued over whether radiation impacts survival; this report confirms a life and death difference. It also indicates that local control of a tumor through radiation makes a difference and keeps it from metastasizing. Unfortunately, this suggests that shorter course radiation treatments currently being experimented with may be ill-advised. But most people would trade six weeks of inconvenience for  a better survival rate." 

 

"This study provides us with more data in regard to the survival advantage of radiation after a lumpectomy. Prior data indicate that the benefit of radiation is predominantly the reduction of recurrence, and not so much survival. This study demonstrates that the survival benefit for the node-negative patients is small: you have to radiate 100 patients to save 3.3, and the other 96.7 patients do not see a survival benefit from the radiation. This data supports the practice of being selective in radiating node-negative patients. For example, elderly patients with stage I breast cancer may have minimal benefit from radiation. However the survival benefit is greater in patients with node-positive disease, and the study reinforces the current recommendation of radiation for patients with more advanced, node positive breast cancer."
 

The second study, by Alice S. Whittemore, PhD, and colleagues at Stanford University, and published in the Journal of Clinical Oncology, reviewed approximately 3,000 families and found
that women who tested negative for a family-specific BRCA mutation do not have any increase in breast cancer risk attributable to that mutation, and, barring other strong risk factors, should follow general population guidelines for breast cancer screening.

"While this isn't breaking news, it is important and it is a sign of the continuing evolution of our understanding of breast cancer. These findings take away one piece of the risk for women who have a family history of breast cancer, but it's a significant piece. It may mean that someone who would have had prophylactic surgery because of a family history of a BRCA mutation will now decide to spare herself that surgery." 

 

"This is saying that, if your family carries a mutation for breast cancer and you do not carry that mutation, your risk is very similar to any woman’s risk for breast cancer. Before this study, some sources felt that, even if you tested negative, you were still at increased risk. It’s a very reassuring finding for women in families which carry a mutation."
 

K.M. Steve Lo, MD, Oncologist, Bennett Cancer Center
The study confirms what we have suspected. These individuals who do not carry the BRCA mutations do not need the intensive screening with MRI, mammogram and Ultrasound. They can be screened the same way as the rest of the population.
 

Barbara A. Ward, MD, Medical Director, Breast Center at Greenwich Hospital

"This is one of the success stories about genetic testing. A 'true negative' occurs when a mother is gene positive and daughter is gene negative. I just had a young patient who is breast feeding find out that she is gene negative. Her mom died after having breast and ovarian cancer. Now I can let the patient breast feed for as long as she wants without worrying about a high risk of breast cancer at her young age."