Radiation oncology considerations in the management of mutation carriers with breast cancer

Abstract

BRCA mutation status has significant implications for local-regional management of breast cancer. Given the strong association of BRCA1-associated breast cancer with TNBC, present guidelines for genetic screening suggest that all TNBC patients younger than 60 years, irrespective of family history, should be considered for genetic testing. Though genetic status will ultimately guide in the local treatment management decisions, the long-term implications with the use of radiation therapy with breast conservation or in the post-mastectomy setting remains unclear in BRCA-associated cancers. The cellular pathways of the BRCA genes are shared with other critical repair pathways may have potential implications for increased toxicity or sensitivity to radiation in BRCA carriers. This chapter reviews the clinical and radiobiologic treatment concepts of radiation therapy, reviews local-regional management principles with breast conservation therapy versus mastectomy in hereditary breast cancers, and provides an overview of the theories and implications of radiation therapy delivery in BRCA mutation carriers.