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#3: author response
British Journal of Cancer - Response to /`Comments on 'The incidence of leukaemia in women with BRCA1 and BRCA2 mutations: an International Prospective Cohort Study/'/'
Sir,
We thank Paradiso et al.
from Bari for examining the Italian data base for correlation with the
reported incidence of leukaemia in the families with BRCA1 and BRCA2
mutations. These authors did not take into account a past history of
breast cancer or the use of cytotoxic chemotherapies in the analysis,
but overall the results lend support to our conclusion that the risk of
leukaemia in mutation carriers is likely to be low, if raised at all (Iqbal et al, 2016).
Friedenson
provides a comprehensive description of the many studies that tie
breast cancer susceptibility genes with propensity to leukaemia, with an
emphasis on immunity and viral carcinogenesis. Little is specific to
the risk in BRCA carriers. He has some concerns that our methods may
have obscured a significant underlying association between BRCA gene
mutations and leukaemia—we have used the same methodology to elaborate
cancer risks for carriers for a range of sites, including pancreas,
colon, breast and ovary. We now accept that there might be a small
iatrogenic risk of leukaemia associated with chemotherapy for breast
cancer in BRCA carriers, but we have also found that chemotherapy is a
highly effective treatment for these patients (Narod et al, 2013; Metcalfe et al, 2015)
and we cannot identify women at sufficiently high risk of leukaemia or
sufficiently low risk of death from breast cancer that they might forego
chemotherapy.
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