Relevance and efficacy of breast cancer screening in BRCA1 and BRCA2 mutation carriers above 60 years: A national cohort study. Issue 12 (20th May 2014)

• Record Type: Journal Article
• Authors: Saadatmand, Sepideh; Vos, Janet R.; Hooning, Maartje J.; Oosterwijk, Jan C.; Koppert, Linetta B.; de Bock, Geertruida H.; Ausems, Margreet G.; van Asperen, Christi J.; Aalfs, Cora M.; Gómez Garcia, Encarna B.; Meijers‐Heijboer, Hanne; Hoogerbrugge, Nicoline; Piek, Marianne; Seynaeve, Caroline; Verhoef, Cornelis; Rookus, Matti; Tilanus‐Linthorst, Madeleine M.; the Hereditary Breast and Ovarian Cancer Research Group Netherlands (HEBON)
• Is Part Of: International journal of cancer. Volume 135:Issue 12(2014:Dec. 15)
• Page Start: 2940
• Page End: 2949
• Publication Date: 2014-05-20
• Subjects: Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.28941
• Languages: English
• ISSNs: 0020-7136

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <p>Annual MRI and mammography is recommended for <italic>BRCA1</italic>/<italic>2</italic> mutation carriers to reduce breast cancer mortality. Less intensive screening is advised ≥60 years, although effectiveness is unknown. We identified <italic>BRCA1/2</italic> mutation carriers without bilateral mastectomy before age 60 to determine for whom screening ≥60 is relevant, in the Rotterdam Family Cancer Clinic and HEBON: a nationwide prospective cohort study. Furthermore, we compared tumour stage at breast cancer diagnosis between different screening strategies in <italic>BRCA1/2</italic> mutation carriers ≥60. Tumours >2 cm, positive lymph nodes, or distant metastases at detection were defined as "unfavourable." Of 548 <italic>BRCA1/2</italic> mutation carriers ≥60 years in 2012, 395 (72%) did not have bilateral mastectomy before the age of 60. Of these 395, 224 (57%) had a history of breast or other invasive carcinoma. In 136 <italic>BRCA1/2</italic> mutation carriers, we compared 148 breast cancers (including interval cancers) detected ≥60, of which 84 (57%) were first breast cancers. With biennial mammography 53% (30/57) of carcinomas were detected in unfavourable stage, compared to 21% (12/56) with annual mammography (adjusted odds ratio: 4·07, 95% confidence interval [1.79‐9.28], <italic>p</italic> = 0.001). With biennial screening 40% of breast cancers were interval cancers, compared to 20% with annual screening (<italic>p</italic> = 0.016). Results remained significant for <italic>BRCA1</italic> and <italic>BRCA2</italic> mutation carriers, and first breast cancers separately. Over 70% of 60‐year old <italic>BRCA1/2</italic> mutation carriers remain at risk for breast cancer, of which half has prior cancers. When life expectancy is good, continuation of annual breast cancer screening of <italic>BRCA1/2</italic> mutation carriers ≥60 is worthwhile.</p> </abstract>