Survival and tumor characteristics of German hereditary breast cancer patients

Reports from different countries have been inconclusive in attempting to re late the BRCA1 mutation status to the survival of breast cancer patients. T he purpose of this study was to investigate overall and disease-free surviv al for German hereditary breast cancer patients. Data on clinical outcome a nd data on age at diagnosis of breast cancer, histology, tumor size, lymph node status, histological grade, and laterality of 36 breast cancer patient s from 12 families with a BRCA1 mutation and from one family with strong ev idence for linkage to BRCA1 were compared with those of 49 hereditary breas t cancer patients from 23 families that did not harbor a BRCA1 mutation. Ov erall and disease-free survival was estimated for both groups. BRCA1 mutati on carriers had a significantly earlier age of diagnosis than non-carriers (p = 0.0001) and more frequently developed contralateral breast cancer (p = 0.04). Also, BRCA1-associated tumors more frequently were of larger size ( p = 0.041) and higher grade of malignancy (p = 0.005) than non-BRCA1-associ ated tumors. Whereas no difference in overall survival was seen, disease-fr ee survival at 10 years differed significantly with 53.3% for BRCA1 mutatio n carriers and 76% for non- carriers (p = 0.02). However, after stratificat ion for age and in multivariate analysis for mutation status, age, and bila terality, it was shown that the worse prognosis for BRCA1 mutation carriers disappeared. Our results suggest that the worse prognosis of BRCA1 mutatio n carriers in terms of disease-free survival may in large part be due to th e age of onset of breast cancer in this population. Thus, BRCA1 mutation st atus does not appear to be an independent prognostic factor.