How would you treat a patient with a small (<0.5 cm) node negative, grade 3 BRCA1 mutated triple negative breast cancer?

In the recently published POSH trial by Copson et al (Lancet Oncology), the investigators examined outcomes in a cohort of women age 40 or younger newly diagnosed with breast cancer. In the overall cohort of 2733 women, 12% had BRCA mutations. After a median follow-up of 8.2 years, there was no significant difference in overall survival between the BRCA-positive and -negative patients at any timepoint. Looking specifically at the triple negative cohort, BRCA mutation carriers had a better overal...

As the POSH trial included very few patients with tumors this size (median size was 2.2 cm, 95% 1.5-3.1 cm) and very few (2%) TNBC patients who did not receive chemotherapy (adjuvant or neoadjuvant), its results are applicable to this case only to reassure us (and the patient) that patients with BRCA1-related TNBC do well with 'standard' treatment - in fact better than non-BRCA patients. How much that's due to chemosensitivity vs. underlying tumor biology we don't know, but I wouldn't use her BR...