Second Breast Cancer not Clear-cut

Ivanhoe Newswire

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(Ivanhoe Newswire) -- Doctors know patients who test positive for BRCA1 or BRCA2 mutations have an increased risk of breast cancer or a second breast cancer. But now, a new study reports patients who do not test positive for BRCA1 or BRCA2 are at a greater risk for a second breast cancer than previously thought.

The study included women with a family history of breast cancer. Out of the 119 participants, 74 women tested positive for a BRCA mutation and 45 did not. All the women in the study opted to have a mastectomy to remove either their affected breast or both breasts (to prevent breast cancer development in unaffected breast tissue). Researchers followed the women to see if a second breast cancer developed over a nine year period. They found a higher than expected presence of the disease in the women who did not test positive for a BRCA mutation.

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Study authors say this research supports the use of prophylactic mastectomy (also called a preventive mastectomy) as an option for women without the BRCA mutation. Prophylactic mastectomy is already an option for those who test positive for the BRCA mutation. Researchers say another option could be sentinel node biopsy for high-risk women, but this option needs more research.

We need a better understanding of cancer in these women to help determine the need for sentinel lymph node biopsy at the time of mastectomy, even in patients in which mastectomy is entirely prophylactic, says Willey. There are risks and serious side effects involved with sentinel node biopsy. We will need to find a balance between offering appropriate care and over-treating these women.

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SOURCE: Presented at the American Society of Breast Surgeons annual meeting in New York City, May 4, 2008

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