Evans AJ et al. (2004) Brain metastases from breast cancer: identification of a high-risk group. Clin Oncol 16: 345–349

Although CNS involvement is rare in early metastatic breast cancer, brain tumors are a common feature of late metastasis and are associated with poor survival. Evans and colleagues from the Nottingham Breast Institute, UK, recently proposed that early intervention might lead to improved survival and quality of life. They set out to characterize brain metastases in breast cancer patients and to identify women at greatest risk.

The records of 219 deceased women with metastatic breast cancer at 70 years of age or younger were used to determine the type, frequency and age of onset of brain tumors, the pathology and estrogen-receptor (ER) status of the primary tumor, and length of survival.

Brain metastases were recorded in 49 patients (22%), 38 of whom had multiple intracerebral lesions. Analysis of data relating to ER status and age of presentation with brain metastases enabled Evans et al. to identify a group of women who had a higher risk (53%) of developing brain tumors: those <50 years old with ER-negative breast cancer. In contrast, there was a 12% risk for women ≥50 years old with ER-positive cancer. There was no association between primary-tumor pathology and development of brain cancer. As brain metastases could develop only in women who lived after responding to treatment, it appeared that women with brain metastases lived longer than women without.

The authors conclude that high-risk patients may benefit from pre-emptive management, such as prophylactic treatment or screening.