| You are here: Home: BCU 4|2002: Program Supplement: Case 1
Miami Breast Cancer
Conference
Tumor Board Case 1: Richard Margolese, MD
A high-risk patient a
with BRCA1 mutation |
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| The patient is a 70-year-old woman
with a history of severe coronary artery disease and
bypass surgery for which she is on multiple medications.
She has 3 daughters with breast cancer and is known
to carry a BRCA1 mutation. How would you manage this
patient?
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A series of actual cases from the faculty were presented to the
attendees at the Miami Breast Cancer Conference, and the audience
voted as to how they would have managed similar patients.
Half of the meeting attendees recommended close surveillance for
Dr Margolese’ s patient, and about one-third would recommend
tamoxifen. Faculty panelists also favored close monitoring, primarily
because in postmenopausal women the risks of thromboembolic disease
and endometrial cancer with tamoxifen may outweigh the benefit.
A subgroup analysis of the NSABP P-1 trial suggested that tamoxifen
does not result in a benefit for BRCA1 patients, but there were
few patients in this analysis.
The IBIS II trial will evaluate the role of anastrozole in this
setting based on the promising contralateral breast cancer risk
reduction and the more favorable toxicity profile encountered with
anastrozole in the ATAC trial. The NSABP STAR trial is currently
evaluating the role of raloxifene compared to tamoxifen in high-risk
women. FOLLOW-UP: Dr Margolese reported that two years after evaluation,
the patient presented with a 6 cm invasive breast cancer, which
was treated with mastectomy.
Duffy SW, Nixon RM. Estimates of the likely prophylactic effect
of tamoxifen in women with high risk BRCA1 and BRCA2 mutations.
Br J Cancer 2002;86(2):218-21. Abstract
King MC et al. Tamoxifen and breast cancer incidence among
women with inherited mutations in BRCA1 and BRCA2: National Surgical
Adjuvant Breast and Bowel Project (NSABP-P1) Breast Cancer Prevention
Trial. JAMA 2001;286(18):2251-6. Abstract
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