Relevance and efficacy of breast cancer screening in BRCA1 and BRCA2 mutation carriers above 60 years: A national cohort study |
| |
Authors: | Sepideh Saadatmand Janet R. Vos Maartje J. Hooning Jan C. Oosterwijk Linetta B. Koppert Geertruida H. de Bock Margreet G. Ausems Christi J. van Asperen Cora M. Aalfs Encarna B. Gómez Garcia Hanne Meijers‐Heijboer Nicoline Hoogerbrugge Marianne Piek Caroline Seynaeve Cornelis Verhoef Matti Rookus Madeleine M. Tilanus‐Linthorst |
| |
Affiliation: | 1. Department of Surgery, Erasmus University Medical Centre, , Rotterdam, The Netherlands;2. Department of Epidemiology, University Medical Centre Groningen, , The Netherlands;3. Department of Medical Oncology, Erasmus University Medical Centre—Cancer Institute, , Rotterdam, The Netherlands;4. Department of Genetics, University Medical Centre Groningen, , The Netherlands;5. Department of Medical Genetics, University Medical Centre Utrecht, , The Netherlands;6. Department of Clinical Genetics, Leiden University Medical Centre, , The Netherlands;7. Department of Clinical Genetics, Academic Medical Centre, , Amsterdam, The Netherlands;8. Department of Clinical Genetics, Maastricht University Medical Centre, , The Netherlands;9. Department of Clinical Genetics, VU University Medical Centre, , Amsterdam, The Netherlands;10. Department of Human Genetics, Radboud University Medical Centre, , Nijmegen, The Netherlands;11. Department of Surgical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, , The Netherlands;12. Department of Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, , Amsterdam, The Netherlands |
| |
Abstract: | Annual MRI and mammography is recommended for BRCA1/2 mutation carriers to reduce breast cancer mortality. Less intensive screening is advised ≥60 years, although effectiveness is unknown. We identified BRCA1/2 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 BRCA1/2 mutation carriers ≥60. Tumours >2 cm, positive lymph nodes, or distant metastases at detection were defined as “unfavourable.” Of 548 BRCA1/2 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 BRCA1/2 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], p = 0.001). With biennial screening 40% of breast cancers were interval cancers, compared to 20% with annual screening (p = 0.016). Results remained significant for BRCA1 and BRCA2 mutation carriers, and first breast cancers separately. Over 70% of 60‐year old BRCA1/2 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 BRCA1/2 mutation carriers ≥60 is worthwhile. |
| |
Keywords: | BRCA1 BRCA2 breast cancer screening mammography |
|
|